Also there is mounting evidence that measles virus is present within the otosclerotic foci, implicating an infectious etiology (this has also been noted in Pagets Disease). Conductive hearing loss (CHL) in otosclerosis is caused by two main sites of involvement of the sclerotic (or scar-like) lesions. The best understood mechanism is fixation of the stapes footplate to the oval window of the cochlea. This greatly impairs movement of the stapes and therefore transmission of sound into the inner ear ("ossicular coupling"). Additionally the cochleas round window can also become sclerotic, and in a similar way impair movement of sound pressure waves through the inner ear ("acoustic coupling"). CHL is usually concomitant with impingement of abnormal bone on the stapes footplate. This involvement of the oval window forms the basis of the name fenestral otosclerosis. The most common location of involvement of otosclerosis is the bone just anterior to the oval window at a small cleft known as the fissula ante fenestram. The fissula is a thin fold of connective tissue extending through the endochondral layer, approximately between the oval window and the cochleariform process, where the tensor tympani tendon turns laterally toward the malleus. The mechanism of sensorineural hearing loss in otosclerosis is less well understood. It may result
from direct injury to the cochlea and spiral ligament from the lytic process or from release of proteolytic enzymes into the cochlea.
According to one commentator, Americans use pauses such as "um" or "em", the Irish commonly use the pause "em", the British say "uh" or "eh", the French use "euh", the Germans say "äh" (pronounced eh or er), the Dutch use "eh", Japanese use "ā", "anō" or "ēto", the Spanish say "ehhh" (also used in Hebrew) and "como" (normally meaning like), and Latin Americans but not the Spanish use "este" (normally meaning this). Besides "er" and "uh", the Portuguese use "hã" or "é". In Mandarin, "那个(nà gè)" and "这个(zhè ge)" are used, meaning "that" or "this", respectively. Arabic speakers say "يعني", the pronunciation of which is close to "yaani", [jæʕni] or [jaʕni], (literally he means, there is no grammatical gender-neutral third person) and Turkish say "şey" in addition to "yani" (without the [ʕ] found in Arabic) and "ııı".Despite the differences between languages, pause fillers in different languages often sound similar because they tend to be the easiest and most neutral vowel sounds to make (such as the schwa), i.e the sounds that can be pronounced with a relaxed tongue or jaw. Research
Recent linguistic research has suggested that non-pathological disfluencies may contain a variety of meaning; the frequency of "uh" and "um" in English is often reflective of a speakers alertness or emotional state.