Malleostapedotomy (MS) is an advanced surgical approach that involves the attachment of a piston prosthesis to connect the malleus with the oval window, instead of the standard stapedotomy of which connects the long process of incus to the oval window. MS is used when the incus is not suitable for attachment. In our case, we operated MS on an 17-year-old female patient who presented with a 5-year history of bilateral progressive conductive hearing loss due to otosclerosis. A Carhart’s notch of up to 30 dB was noted on the right ear, with severe right-sided hearing loss and air-bone gap (ABG) of 48.75 dB. During her endoscopic stapes surgery, mobility test showed significant pan-ossicular fixation, necessitating removal of malleus head, incus, and stapes suprastructure. The stapedotomy was then sealed with a perichondrium graft. A 0.6 mm × 5 mm teflon piston prosthesis was placed between the malleus handle and the sealed oval window. At 2 month postoperative follow up, pure tone audiometry showed a mild right side conductive hearing loss and ABG of 25 dB. To date, the experience with MS is still evolving. As such, different surgical approaches and techniques utilizing variable prosthesis for a range of indications are being reported. Many otologists still prefer not to perform MS due to its surgical complexity, especially when using an endoscopic technique. We believe that every surgeon performing stapes surgery should be familiar with MS as an intraoperative option for cases involving incus pathology, fixation, or iatrogenic incudostapedial subluxation.

The effective detection of environmental vibrations such as sound waves depends on the transmission of tympanic membrane motion through the middle ear to the inner ear hair cells. In birds, the bony element of the middle ear is the columella; its distal end joins the cartilaginous extracolumella and tympanic membrane, while its basal expansion (the footplate) interfaces with inner ear fluid at the oval window, where it is held in place by the stapedial (columellar) annular ligament. Variation in footplate and oval window geometry can alter the annular ligament's size and shape, thereby influencing middle ear mechanics. Previous studies have noted relatively small footplates in aquatic birds as compared to their terrestrial relatives, and suggested that the adaptive significance of these may relate to their influence on the relative size of the annular ligament. Here, I examine a taxonomically and ecologically broad sample of bird species to test the hypothesis that aquatic lineages have convergently evolved proportionally larger annular ligaments. Results show larger ligaments are characteristic of aquatic, and particularly diving species, while narrower ligaments occur in high-frequency specialists. These patterns are polyphyletic and, alongside their strong ecological associations, indicate repeated functional adaptation of the middle ear. Larger ligaments are consistent with reduced system stiffness and enhanced low-frequency transmission, a hypothesis which is plausible for pelagic seabirds. In contrast, the extreme ligament enlargement in diving taxa is unlikely to be related to hearing, and instead may play a role in protection from barotrauma.

Background With the existing experimental techniques, it is unable to measure the overall structural vibration of the human ear, which is difficult to reflect the relationship between hearing and ear structures. Aims/Objectives The overall biomechanical behaviour of the whole ear structure during sound perception is described. Methods Based on CT scanning data and knowledge of ear physiology, a 3D whole ear numerical model was developed that conforms to the actual physiological environment of the human body. Results The outer ear canal (EC) has an amplifying effect on sound conduction. The middle-lower part of tympanic membrane (TM) is susceptible to damage, which is mainly reflected in the high-tendency of clinically TM perforation phenomenon. Similarly, TM’s damage or hypoplasia is also common. Peak amplitude occurs at the center of one-side of the oval window membrane (OWM) and the center of the round window membrane (RWM), respectively, and these areas are prone to disruption and more severely may evolve into perilymph fistulas. The BM’s amplitude changes longitudinally along the cochlear helix as frequency increases. Conclusions and Significance This model reflects the impact of localized structural damage on hearing under the coordinated working of the whole ear (outer, middle and inner ears).

Isolated congenital middle ear malformation (CMEM) contributes significantly to congenital hearing loss and growth problems. This study aims to compare 0.1-mm isotropic ultra-high-resolution CT (U-HRCT) and conventional high-resolution CT (HRCT) for assessing isolated CMEM, using surgical exploration as the standard. This single-center retrospective study included patients with surgically confirmed isolated CMEM who underwent U-HRCT or HRCT from January 2015 to April 2025. Middle ear abnormalities were identified based on operative outcomes and 4 subtypes were classified via the Teunissen standard. Two neuroradiologists blinded to surgical outcomes reviewed CT images for 10 subtle structural abnormalities and specific subtypes. The comparison of U-HRCT and HRCT in terms of interobserver and intraobserver agreement and detection of structural abnormalities and subtypes of CMEM were analyzed. The U-HRCT and HRCT groups included 61 patients (69 ears) and 37 patients (44 ears), respectively. U-HRCT exhibited significantly higher interobserver and intraobserver agreement and stronger concordance with surgical findings for all 10 abnormalities compared with HRCT. It also showed superior diagnostic sensitivity for CMEM (100.0% versus 90.9%; P = .013) and outperformed HRCT in differentiating clinical subtypes (0.774 versus 0.352; P<.001). U-HRCT achieved accuracies exceeding 0.85 in identifying all abnormalities and outperformed HRCT in detecting specific abnormalities including abnormal long process of the incus, lenticular process, abnormal stapes superstructure, stapes footplate fixation, and oval window atresia (P < .05). Isotropic 0.1-mm U-HRCT significantly outperforms conventional HRCT in diagnosing CMEM, differencing subtypes, and detecting subtle abnormalities, supporting its clinical superiority for precise preoperative evaluation.

To report a rare case of a marked improvement in bone conduction (BC) thresholds following the reinforcement of the oval window (OW) prior to the implantation of a total ossicular replacement prosthesis (TORP). A clinical case involving OW reinforcement followed by TORP implantation was retrospectively analyzed, with pre- and postoperative pure tone averages (PTA) at four frequencies for BC and air conduction (AC) measured and compared. The bone conduction PTA across four frequencies improved significantly from 62dB preoperatively to 16dB postoperatively in the patient's only hearing ear, which had previously experienced acute hearing loss and was affected by cholesteatoma. Concurrently, the AC PTA also improved, decreasing from 76dB to 33dB. In patients presenting with benign middle ear lesions that result in destruction of the stapes footplate and concomitant reduction in BC, it is essential to first exclude sensorineural etiologies, including labyrinthitis and auditory neuropathy. Subsequently, consideration should be given to reinforcing the OW utilizing autologous cartilage.

Congenital malformations of the middle ear, particularly those affecting the ossicular chain and stapes, are uncommon yet significant causes of conductive hearing loss. Here, we report a unique case of stapes malformation with an empty oval window and provide a review of the literature to contextualize our findings. We present the detailed diagnostic and therapeutic course of a 21-year-old female with unilateral conductive hearing loss, focusing on imaging, intraoperative findings, and management strategy. A comprehensive literature review (January 1950-January 2025) was undertaken in major databases. Preoperative high-resolution computed tomography (HRCT) revealed no apparent abnormalities. Exploratory tympanotomy, however, identified a malformed stapes located on the promontory, below an empty oval window covered by fibrous tissue. No bone was felt on palpation. In light of the risk for perilymphatic gusher and the moderate degree of hearing loss, surgical reconstruction was not performed. The patient was managed with hearing amplification, achieving satisfactory rehabilitation and no complications. Malformations of the stapes and oval window demonstrate significant anatomical variability and can be difficult to diagnose using imaging alone. Surgical exploration remains crucial, and in the setting of an empty oval window, a tailored, conservative approach may be favored to minimize morbidity.

To characterize the clinical features, management, outcomes, and predictors of recurrence of cerebrospinal fluid otorrhea in patients with inner ear malformations. This retrospective cohort study included 40 patients with inner ear malformation-associated cerebrospinal fluid otorrhea who underwent surgical repair at our institution between January 2009 and December 2024. Data on patient demographics, clinical presentation, imaging findings, surgical management, and outcomes were collected and analyzed. The cohort predominantly comprised minors (97.5%, 39/40), with a mean age of onset of 5.83 years. Young children (≤7 y) accounted for 80% (32/40) of patients. Meningitis was the most common presenting symptom (75%), and the overall incidence throughout the disease course was 97.5% (39/40). Recurrent meningitis was observed in 57.5% (23/40) of patients preoperatively, with the frequency of episodes significantly correlating with the duration of the preoperative interval. Radiologically, an incomplete partition type I (IP-I) malformation was the most prevalent inner ear anomaly, and the cerebrospinal fluid (CSF) leakage sites were almost exclusively localized to the oval window region. The initial surgical success rate was 77.5% (31/40), with most recurrences occurring within 2 years postoperatively. Causes of recurrence included reperforation at the primary leak site, misdiagnosis, missed diagnosis, and failure to address the oval window region. Cerebrospinal fluid otorrhea associated with inner ear malformations primarily afflicts the pediatric population and most commonly presents as meningitis. Early and accurate diagnosis is critical for definitive management. The selection of an optimal surgical approach and meticulous repair technique are pivotal for achieving a high cure rate and minimizing the risks of failure or recurrence.

The human ear is a complicated organ with unique anatomy and composition. Ototopical administration has become an interest recently. However, an effective drug delivery to the ear is not easy, as there are many otic obstacles such as tympanic membrane, blood labyrinth barrier, endolymph-perilymph barrier, and middle inner ear barriers (oval window and round window). Nanovesicular drug delivery carriers have the ability to entrap hydrophilic and lipophilic drugs, increase drug stability, sustain residence time, enhance otic permeability, and increase bioavailability. The objectives of this review are to describe ear anatomy, different otic diseases, and challenges for ear drug delivery. Also, it discusses different nanovesicular drug delivery systems including their characterization methods, advantages, limitations, and applications in ear drug delivery for the treatment of different ear diseases. These systems can manage solubility, safety, bioavailability, efficiency, and stability issues existing in conventional drug delivery systems.

Otosclerosis is a disease affecting the middle and inner ear, characterized by abnormal bone remodeling that leads to stapes fixation and progressive hearing loss. Although high-resolution computed tomography (HRCT) is the standard imaging modality for diagnosis, its sensitivity is limited, with a high false-negative rate (FNR). This study investigates the use of radiomics and machine learning (ML) to improve diagnostic accuracy. HRCT scans from 99 subjects (48 otosclerosis, 51 controls) were analyzed, focusing on the stapes, antefenestral region (AF), and oval window (OW). From each scan, 6048 radiomic features were extracted and reduced to 1317 through feature selection. Statistical analyses and ML modeling were performed using the selected features. Sixty-seven biomarkers showed significant differences between cases and controls, primarily in the AF (56) and stapes (11); none were found in the OW. Both the AF and stapes exhibited increased heterogeneity in otosclerosis, reflecting the bone remodeling process. A reduction in the stapes' major axis was also observed, possibly related to torsional deformation. Image transformation filters enhanced disease visibility. Among several ML classifiers tested, L2-regularized logistic regression performed best, achieving an AUC of 0.90 ± 0.06, thereby enhancing the diagnostic accuracy reported in some studies for radiologists. Hierarchical clustering of the most predictive features further confirmed their strong discriminative power. Our findings highlight the potential of radiomics and ML to standardize otosclerosis diagnosis, reduce FNR, and support surgical decision-making. Future studies should validate these results using larger cohorts and advanced imaging technologies such as Photon-Counting CT.

To analyze the efficacy of tympanoplasty for severe tympanosclerosis under the continuous irrigation mode. Retrospective. First Affiliated Hospital of Wenzhou Medical University. Patients with severe tympanosclerosis involving critical anatomic structures (eg, stapes footplate, facial nerve canal, vestibular window niche). Tympanoplasty with continuous irrigation mode. Saline irrigation to reduce bleeding, improve surgical continuity, and shorten operative time. Removal of calcified lesions and ossicular chain reconstruction. Surgical efficacy (assessed by completeness of lesion removal and hearing improvement), operative time, frequency of endoscope withdrawal for cleaning, complication rates (including facial paralysis, vertigo, sensorineural hearing loss, and taste disturbances), tympanic membrane healing status, chorda tympani preservation rate, and feasibility in overcoming traditional limitations (eg, single-handed operation, bone drilling difficulties). Reduced intraoperative bleeding. Improved procedural continuity. Shortened operative time. Enhanced feasibility for complex lesions (eg, near facial nerve). Postoperative outcomes improved with reduced complication rates. The continuous irrigation mode represents a safer and more effective advancement in tympanosclerosis surgery, addressing limitations of conventional endoscopy by improving efficiency and reducing complications. Further clinical validation is needed.

Sensorineural hearing loss (SNHL) represents the most common sensory deficit in humans and is increasingly prevalent with aging. Despite diverse etiologies, irreversible degeneration of cochlear hair cells and neurons remains a final pathway for auditory decline. This narrative review synthesizes current preclinical and early clinical evidence on gene- and stem cell-based strategies for congenital and acquired SNHL, highlighting translational progress, delivery innovations, and persisting limitations. A structured literature and registry search (PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov, EudraCT) was conducted using Boolean combinations of disease-, gene-, vector-, and delivery-related terms. From 140 initial records, 46 eligible studies were included after full-text screening. Data were qualitatively analyzed across two streams-human clinical (gene therapy) and preclinical/experimental (gene editing, RNA-based modulation, stem-cell regeneration). Two independent first-in-human AAV-mediated OTOF replacement trials in children with DFNB9 demonstrated partial restoration of hearing, establishing the first clinical proof-of-concept for cochlear gene therapy. Preclinical studies confirm durable auditory and vestibular rescue using dual-AAV systems, while CRISPR-based editing, antisense oligonucleotides (ASOs), and RNA interference (RNAi) approaches show mechanistic feasibility. Induced pluripotent stem cells (iPSCs) and inner-ear organoids replicate key developmental pathways, supporting modeling and future cellular repair. Delivery precision via the round window, oval window, and microneedle systems remains the major translational bottleneck. Gene- and cell-based approaches are transforming auditory regenerative medicine. Among them, AAV-mediated OTOF replacement has reached clinical validation, whereas CRISPR, ASO/RNAi, and iPSC-derived regeneration continue at advanced preclinical stages. Future success will depend on refining delivery, ensuring long-term safety, and harmonizing ethical and regulatory oversight.

Cases historically presumed to be perilymphatic fistula of the round and/or oval window may be cases of third window syndrome due to inner ear dehiscence. Perilymphatic fistula (PLF) is a condition where a pathologic external connection of the perilymphatic space is present, often with an associated otic capsule or stapes defect. Recently, it has become evident that otic capsule defects in locations that lack perilymphatic fluid leak can cause clinical symptoms. Such clinical entities are deemed "third window" syndromes-among which superior semicircular canal dehiscence is the most common. Human temporal bone specimens underwent histopathologic study of cases previously suspected to have PLF at the oval or round window. These specimens were further scrutinized for the presence of an alternate site of inner ear dehiscence that may have potentially caused a third window syndrome. Thirty-one out of 34 of the cases (61 ears) from a previously published study on PLF were reviewed. Altogether, dehiscences were noted at the following locations: cochlea-facial (11), superior semicircular canal (5), endolymphatic sac-jugular bulb (4), cochlea-internal auditory canal (3), posterior semicircular canal (2), and an enlarged/patent cochlear aqueduct (2). One patient with a histologic dehiscence had an audiogram consistent with third window syndrome. The findings suggest that many clinical cases historically presumed to be PLF of the round and/or oval window may, in fact, be cases of third window syndrome due to inner ear dehiscence with pathology at sites other than the oval or round windows.

BackgroundTranscanal endoscopic ear surgery (TEES) is becoming increasingly popular in otologic surgery and can be considered the first choice for stapes surgery. In this study, we analyzed a case series of TEES for stapes surgery, focusing on the estimation of appropriate prosthesis length using preoperative CT based on postoperative hearing results.MethodsWe retrospectively examined 31 patients who underwent TEES using a rigid endoscope for stapes surgeries. Postoperative hearing results were good in 27 cases (87.1%) and poor in four cases (12.9%). We reviewed the preoperative CT scans of all the patients and measured the straight-line distance from the incudostapedial joint to the oval window in the coronal images, assuming it to be the estimated appropriate prosthesis length (eAPL).ResultsThe actual length of the prosthesis inserted during the operation was shorter than the eAPL in three of the four cases without postoperative hearing improvement. In the remaining patients, postoperative CT indicated that the prosthesis position was inadequate.ConclusionThe measurement of the APL using preoperative CT could contribute to improving postoperative hearing outcomes after stapes surgery using TEES.

The Bonebridge hearing aid (Med-EL, Innsbruck, Austria) is a semi-implantable hearing system with transcutaneous bone conduction that was implemented in Europe in 2012. It is indicated for patients with conductive and mixed hearing loss or unilateral profound sensorineural hearing loss, who do not obtain adequate benefits with conventional hearing aids and are not candidates for middle ear reconstructive surgery. The Bonebridge device, being an active transcutaneous bone conduction implant, can overcome the disadvantages of percutaneous bone conduction devices. The Vibrant Soundbridge hearing aid (Med-EL, Innsbruck, Austria) was implemented in Europe in 1996 as an implantable hearing device in the middle ear in patients with mild to severe sensorineural, conductive or mixed hearing loss with medical and audiological contraindications for the use of conventional hearing aids or with rapidly progressive sensorineural hearing loss. The Bonebridge and Vibrant Soundbridge devices, used in patients with the same indication criteria, had similar audiological results – adequate hearing rehabilitation with improvement of subjective hearing (perception of silent and noisy speech, spatial hearing, hearing quality, sound localization), a significant increase in perceived quality of life and patients’ satisfaction with the hearing aid (comfort, sound quality, cosmetic appearance). Because the Vibrant Soundbridge device requires the floating mass transducer to be coupled to the ossicles, round window, or oval window, this surgery carries a higher risk of inner ear injury than surgery with the Bonebridge device. The advantages of the Vibrant Soundbridge system, compared to the Bonebridge device, are the potential for greater stimulation power, especially at high frequencies, unilaterally stimulating the affected ear without influencing the contralateral ear through bone conduction.

The isolated petrosal bone from the early Late Cretaceous (early Cenomanian) Khodzhakul Formation at the Sheikhdzheili locality in western Uzbekistan is similar to the petrosal of the Early Cretaceous eutherian Prokennalestes in that they both have a transpromontorial course of the internal carotid artery, a prootic canal, a lateral flange, and a large stapedius fossa. Both also lack a deep cochlear fossula. However, it differs from the petrosal of Prokennalestes in the lateral flange unreduced lateral to the promontorium, the fenestra vestibuli being more elliptical, with a stapedial ratio of 2.38; the cochlea being more tightly coiled (487° or 1.35 turns); the position of hiatus Fallopii within the petrosal; cavum supracochleare open dorsally; and the crista interfenestralis showing a curved posterior extension similar to that of Zalambdalestidae. The petrosal bone from the Sheikhdzheili locality is similar to that in an asioryctitherian Uchkudukodon from the younger (late Turonian) Bissekty Formation in Uzbekistan, as evidenced by the pattern of grooves for the stapedial and internal carotid arteries on the promontorium, as well as the presence of an unreduced lateral flange. It may belong to an asioryctitherian, a group currently unknown from the Sheikhdzheili locality based on dental remains.

To examine the association of extent of otosclerotic plaque using high-resolution photon-counting computed tomography (PCCT) with hearing and surgical outcomes. Historical cohort. Large academic center. Patients with otosclerosis who completed PCCT imaging at time of initial evaluation. Observation, surgery. Audiometric data. A total of 53 ears were eligible for study. The mean age at PCCT was 51 years (SD: 14). The mean extent of oval window otosclerotic plaque measured in radial degrees was 112 (SD: 65) and the mean otosclerotic depth was 1.6mm (SD: 0.6). The mean air-bone gap pure-tone average was 18 dB (SD: 12) and the mean Carhart degree was 9 dB (SD: 10). The radial degrees of oval window extent were not significantly associated with air-bone gap (correlation coefficient: 0.14; P =0.3) or Carhart degree (correlation coefficient: 0.04; P =0.8). Likewise, otosclerotic plaque depth was not significantly associated with air-bone gap (correlation coefficient: -0.19; P =0.2) or Carhart degree (correlation coefficient: -0.08; P =0.6). After PCCT, 22 ears underwent surgery. In this subset, oval window extent and plaque depth were not significantly associated with the postoperative changes in air-bone gap or high-frequency thresholds. Despite enhanced visualization of subtle abnormalities with PCCT imaging, the extent of oval window otosclerotic plaque, measured in angular degrees and depth, was not associated with hearing loss at time of initial evaluation or postoperative audiologic changes in patients with otosclerosis.

Stapedotomy is performed to restore ossicular chain sound transmission by inserting a piston prosthesis that couples the long process of the incus to the oval window, thereby addressing conductive hearing loss associated with otosclerosis. This study investigates the effects of crimping force, prosthesis material, and loop geometry on incus to optimize fixation while minimizing complications such as incudal necrosis. Finite element analyses were performed to quantify interface pressures and von Mises stresses for titanium prostheses with loop-band widths of 0.2, 0.3, and 0.5 mm under crimping forces of 300–500 mN and for polytetrafluoroethylene (PTFE) prostheses with loop outer diameters (OD) of 1.2, 1.4, and 1.8 mm. The analysis results showed that PTFE prostheses generated significantly lower interface pressures and stress compared to titanium. For PTFE prostheses, the equivalent von Mises stresses remained well below the critical threshold, with values ranging from 3.5 MPa up to peaks of approximately 43 MPa depending on the loop’s outer diameter. In contrast, titanium prostheses exhibited a marked dependency on crimping force and band width. At a force of 300 mN, stresses were modest (approximately 16–24 MPa). However, when increasing the force to 400 mN, stresses approached the critical threshold (up to approximately 53 MPa). With crimping forces of 500 mN, especially with band widths greater than 0.3 mm, stresses exceeded the cortical bone strength threshold (approximately 61–64 MPa), indicating an increased risk of mechanical overload and potential incudal necrosis. These findings highlight the importance, in a clinical context, of controlling the crimping force and selecting the material and geometry of the prosthesis to achieve secure coupling while preserving the incus’s structural integrity.

Objective:To describe a novel approach for intractable Meniere's disease exclusively through a transcanal endoscopic ear surgery（TEES）. Methods:This retrospective chart review included patients with intractable Menière's disease who underwent endoscopic transcanal labyrinthectomy in the Department of Otolaryngology Head and Neck Surgery, Guangxi Hospital Division, First Affiliated Hospital, Sun Yat-sen University, between February 2023 and October 2024. The first 70-year-old woman and the other 67-year-old woman, who underwent multiple conservative treatment and chemical labyrinthectomy during outpatient and hospitalization, had frequent vertigo, tinnitus and severe sensorineural deafness. The TEES approach provided a wide exposure of the oval window. The incus and the stapes were removed, expanded the oval window. The perilymph was suctioned, The saccule, utricule, macula utriculi and macula sacculi were removed. The ampulla tissue of the three semicircular canal were destroyed with the right-angle crochet. The oval window was obliterated using the perichondrium of the tragal cartilage and cartilage. Results:Two patients underwent endoscopic transcanal labyrinthectomy, and no intraoperative or postoperative complications were observed. Vertigo was controlled in 2 patients during the follow-up of 6 to 12 months. Two patients complained of total hearing loss after surgery. Conclusion:Even though this study presents a limited number of cases, endoscopic transcanal labyrinthectomy is a promising, safe, and effective procedure in selected cases. Additional studies are needed to determine the risk-benefit profile of this technique.

Bilateral vestibular dysfunction disrupts balance and spatial orientation, yet mechanisms of injury and compensation remain incompletely defined. We established a mouse model of bilateral acute inner-ear (labyrinthine) injury with vestibular involvement by sequentially incising the round and oval windows, and evaluate auditory brainstem responses (ABR), vestibular sensory-evoked potentials (VsEP), behavior, and histology across postoperative days 1-28. Threshold elevations and behavioral impairment peaked on day 3, with hair-cell degeneration most prominent early and partial morphological recovery by day 28. These findings delineate the acute injury phase and early stabilization, providing a platform to study vestibular repair and functional recovery.

Objective: To evaluate the effectiveness, functional outcomes, and surgical advantages of endoscopic stapes surgery in patients with otosclerosis, based on a three-year experience at the Otolaryngology Department of Avicenne Military Hospital in Marrakech. Materials and Methods: We conducted a retrospective study of patients operated on for otosclerosis between January 2020 and January 2023. All surgeries were performed using a transcanal endoscopic approach, involving a fully calibrated small-fenestra platinectomy and titanium prosthesis insertion, without the use of a surgical microscope. Patients were assessed pre- and postoperatively with audiometry (pure-tone average, air–bone gap), tympanometry, and postoperative functional evaluation. Results: A total of 36 patients were included (28 women, 8 men; mean age: 38.5 years). Unilateral stapedotomy was performed in all cases, and no conversion to microscopic surgery was required. The mean preoperative air–bone gap (ABG) was 33 dB. At 3 months postoperative follow-up, closure of the ABG to &lt;10 dB was achieved in 83%, with a mean postoperative ABG of 8.2 dB. No severe complications occurred; minor transient vertigo was reported in 14% of patients, and temporary taste disturbance (chorda tympani stretch) in 11%. No persistent tympanic perforations or sensorineural hearing losses were observed. Conclusion: Endoscopic stapes surgery represents an efficient, safe, and minimally invasive alternative to traditional microscopic stapes surgery. Its advantages include wide-angle visualization, improved exposure of the oval window niche, and enhanced identification of anatomical variations. Based on our experience, endoscopic surgery offers excellent hearing outcomes and low complication rates, making it a valuable technique in modern otologic practice.