Otosclerosis

A 32-year-old woman presents with progressive bilateral hearing loss over the past 18 months. She reports tinnitus and occasional vertigo. On examination, Weber test shows bone conduction better than air conduction bilaterally (bone conduction threshold 20 dB, air conduction threshold 40 dB). Otoscopy reveals a normal tympanic membrane. Audiometry confirms conductive hearing loss with an air-bone gap of 20 dB. CT temporal bone shows bilateral stapes fixation with normal ossicular chain. What is the most likely diagnosis?

A 28-year-old woman who is 6 months pregnant presents with progressive hearing loss bilaterally over the past 3 months. She denies tinnitus or vertigo. Otoscopy is normal. Audiometry shows an air-bone gap of 15 dB with a characteristic bone conduction peak at 2 kHz. Her mother had similar hearing loss requiring surgery at age 35. CT temporal bone shows bilateral radiolucent foci at the anterior oval window with stapes footplate fixation. What is the most appropriate next step in management?

In otosclerosis, the primary pathological process involves abnormal bone remodeling at which anatomical site?