Otosclerosis is one of the more common forms of adult onset hearing loss.

It is typically characterized by a conductive hearing loss, a fixation (labyrinthine endochondral sclerosis) of the stapes. Its aetiology remains poorly understood with both environmental factors and genetic causes implicated in its development.

Stapes surgery is considered the gold standard procedure to restore the mechanical sound transmission through the middle ear; nevertheless, a hearing aid can always be considered a valid alternative for patients who are not eligible for surgery. The operation is traditionally carried out under a general anaesthetic. The approach is through the ear canal and requires, with the use of a microscope/endoscope, lifting up the eardrum. 

A small atticotomy (small amount of bone removed from the ear canal) is normally carried out ceeding with the removal of the stapes and replacement with a prosthesis, the diagnosis of Otosclerosis is made, checking that the stapes is fixed. 

The procedure itself sees the disarticulation of the incudostapedial joint (Joint between the 2nd bone of the middle ear called the incus and the 3rd bone called the stapes). With a KTP laser, the tendon of the stapedius muscle and the posterior arm of the stapes are cut (posterior crurotomy). The fracture of the anterior crus towards the promontory and subsequent removal of the stapes suprastructure is performed. A small hole in the footplate is performed and a piston is positioned to replace the function of the stapes. All prostheses are MRI compatible. 

The eardrum is then unfolded and some packing in the ear canal positioned and left for 10 days to help the healing process and prevent infections.