Outcomes and Predictive Factors of Success in Stapes Surgery: A Multicentric Retrospective Analysis

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 <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.

To investigate the correlation between otic capsule demineralization and pre- and postoperative hearing parameters in patients with otosclerosis. Retrospective study. University hospital. A total of 181 ears from152 consecutive patients (39 men; 113 women) with otosclerosis who underwent stapes surgery between January 2003 and December 2020. High-resolution computed tomography was used to identify otic capsule demineralization, observed as hypodense areas. Preoperative and 12-month postoperative hearing parameters were compared between ears with and without demineralization and further analyzed according to the number of demineralization loci in the affected group. Demineralization was observed in 96 ears (53%), while 85 ears showed no hypodense areas. Preoperative air-conduction (AC) thresholds were significantly worse in the demineralization (+) group due to a larger air-bone gap (ABG), with no significant difference in bone-conduction (BC) thresholds between the groups. Postoperatively, AC remained significantly worse in the demineralization (+) group due to a persistently larger ABG. However, no significant differences were found in postoperative BC thresholds or in the degree of closure of the ABG between groups. The number of demineralization loci (single, double, or triple) was not significantly associated with pre- or postoperative hearing outcomes. Although both pre- and postoperative AC and ABG were worse in the demineralization (+) group, the similar degree of closure of the ABG observed in both groups supports stapes surgery as an effective treatment for otosclerosis, regardless of the presence or extent of otic capsule demineralization.

To investigate the effect of semicircular canal dehiscence (SCD) on surgical outcomes in patients with otosclerosis. Case series with chart review. Tertiary referral center. Eighteen patients were identified with concomitant, clinically suspected otosclerosis and radiographic SCD. Eight patients underwent primary stapes surgery, 2 underwent revision stapes surgery, 6 were advised against surgery, and 2 patients were evaluated after unsuccessful stapes surgery done elsewhere and had worsened hearing or unmasked third-window symptoms. Some patients were not offered stapes surgery due to presumed higher risk.Intervention(s):Review audiometric, and radiographic evaluations of patients who were diagnosed with both otosclerosis and SCD.Main outcome measure(s):Preoperative and postoperative audiometry, radiographically measured approximate dehiscence area (ADA), and symptoms in patients with otosclerosis and semicircular canal dehiscence were evaluated. Six of 8 (75%) primary stapedotomy patients had closure of the air-bone gap (ABG) to <10dB, while 1 patient had >20dB ABG. Both revision stapedotomy patients had >20dB ABG postoperatively. No patients operated by the authors reported unmasking of third-window symptoms after stapes surgery. ADA was not significantly different in patients in the unoperated versus primary/revision stapes surgery group. One patient who had a present cVEMP threshold did not close their ABG after stapes surgery, whereas 2 patients with absent cVEMP thresholds did. In select patients, stapes surgery can result in improved hearing when otosclerosis and SCD coexist. Measurements of dehiscence area were not shown to predict surgical outcomes. CT imaging combined with VEMP testing appear to be valuable tools to assess risk of stapes surgery.

To evaluate the functional results of robot-assisted laser guidance in otosclerosis surgery. Retrospective case-control study. Otology/neurotology tertiary referral clinic. Patients operated for primary microscopic stapes surgery performed by a single surgeon from August 2018 to October 2022 using the robot-assistance or the manual technique. Primary otosclerosis surgeries with robot-assistance or the conventional manual technique. Evaluation of the audiologic outcome of air conduction, bone conduction, air-bone gap and speech recognition threshold at 3 months and 1 year postoperative. Intraoperative observations, prosthesis choice, and operation duration were collected. A total of 74 patients were operated on for otosclerosis, of which 45 patients were operated on with robot-assistance, and 46 with the conventional manual technique. A reduction of laser shots (2 vs. 3) was necessary to perform footplate fenestration in the robot-assisted group (P<0.02). Both groups had similar audiometric outcomes. In the robot-assisted group, successful closure of an air-bone gap of <15dB was achieved in 94% of patients at 3 months, and in 100% at 1 year, compared with 92% at 3 months (P>0.99) and 97% at 1 year (P<0.48) in the manual group. Air-bone gap closure of <10dB was attained in 86% and 82% at 3 months (P<0.76) and 97% and 93% at 12 months (P<0.61) in the robot-assisted and manual groups, respectively. Both groups improved postoperatively in air conduction thresholds and air-bone gaps while maintaining a stable bone conduction. This study reports the use of robot assistance as a laser holder for otosclerosis surgery, which indicates similar audiologic outcomes and no major complications. Robot-assisted otosclerosis surgery is a reliable and safe technique.

ABSTRACTObjectiveMastering otosclerosis surgery is challenging, especially in low‐prevalence Asian populations. This study defines the learning curve for a single surgeon's first 100 consecutive CO2 laser‐assisted stapedotomies by analyzing audiometric and complication outcomes. Despite widespread descriptions of laser‐assisted stapes surgery, there is a paucity of data examining the learning process in low‐incidence, low‐volume regions like East Asia. We aim to characterize the unique challenges and surgical adaptations required in such an environment.MethodsA retrospective review of 100 primary stapedotomy cases was performed. The proficiency changepoint was identified using Bayesian and cumulative sum (CUSUM) analyses based on success (postoperative air‐bone gap [ABG] ≤ 10 dB and no significant bone‐conduction deterioration). Audiometric outcomes—including postoperative ABG, achievement of “Negative ABGe” (postoperative air conduction superior to preoperative bone conduction), and change in high‐tone bone conduction—were compared between the pre‐proficiency (cases 1–30) and post‐proficiency (cases 31–100) phases.ResultsA proficiency changepoint was robustly identified at 30 cases. Subsequently, outcomes improved significantly: mean postoperative ABG decreased from 12.1 dB to 5.2 dB (p < 0.001), and the success rate (ABG ≤ 10 dB) increased from 53.3% to 91.4%. The rate of achieving a Negative ABGe surged from 3.3% to 50.0% (p < 0.001). The mean change in high‐tone bone conduction also shifted from −0.3 to +6.1 dB of overclosure (p < 0.001). All major complications occurred within the initial 30 cases.ConclusionFor CO2 laser‐assisted stapedotomy, proficiency significantly improves after approximately 30 cases. This study uniquely highlights how surgical mastery develops under conditions of limited disease prevalence and restricted training exposure. The findings suggest that even in low‐volume environments, structured experience enables not only consistent ABG closure but also meaningful gains in patient‐centered outcomes such as Negative ABGe and cochlear preservation. Our results advocate for simulation‐enhanced education strategies tailored to resource‐constrained surgical contexts.Level of Evidence4.

Impact of prosthesis position on hearing outcomes in otosclerosis patients based on ultra-high-resolution CT.

Otosclerosis is a progressive, autosomal dominant hereditary disease of temporal bone causing tinnitus, and conductive hearing loss. Stapes surgery is safe and effective treatment with evidence suggesting tinnitus improvement corelates with hearing restoration. This systematic review evaluates evidence related to tinnitus improvement and hearing restoration following stapedectomy. This systematic review was prepared in accordance with the Preferred Reporting Item for Systematic Review and Meta-Analysis-P statement. The search included bibliographic databases like MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health Literature, and Cochrane Library from inception until June 2024. The review included all studies reporting tinnitus severity and hearing outcomes post-stapes surgery. Outcome measures were tinnitus severity, hearing improvement, and timeframe of improvement. This review was registered with PROSPERO (CRD42024566593). The initial search generated 609 studies from multiple databases, of which 22 studies involving 2233 patients were included. Due to heterogeneity in study design, patient population, and outcome measures used, pooling of data for meta-analysis was not feasible. Most of the studies were prospective in nature (77.3%), conducted in university hospitals (45.5%), and the average mean age of patients ranged from 18 to 75 years, predominantly females (60.7%). Most studies reported improvement of tinnitus severity post-stapes surgery 15.7% to 64% (median 46.3%), only fewer studies noted worsening among 2.9% to 11% patients. Hearing outcomes were consistently positive among majority of the studies, and only a small subset of patients reported no improvement or worsening. There was a moderate-to-strong relation between tinnitus improvement and air-bone gap (ABG) closure (32%), tinnitus resolution versus ABG closure (55%). More than 50% of the studies reported adherence to the Strengthening the Reporting of Observational Studies in Epidemiology quality assessment checklist. The systematic review indicates that stapes surgery improves degree of tinnitus severity and hearing outcomes and has moderate-to-strong correlation between resolution in tinnitus versus ABG closure. Most patients experienced significant improvement within 6 months.

The aim of this study was to investigate the influence of type of anesthesia on audiometric results, surgery duration, quality-of-life and complications associated with stapes surgery in patients with otosclerosis. A comprehensive literature search was conducted in five databases, including PubMed, Embase, SCOPUS, WoS, and Google Scholar. We have identified studies comparing the outcomes of stapes surgery under local-anesthesia (LA) versus general-anesthesia (GA) and published up to 30 May 2025. All analyses were performed using Comprehensive-Meta-Analysis-software and Review-Manager. Operating room occupancy was significantly lower in surgery under LA than GA (MD = -17.27 min, 95% CI [-24.72, -9.83], p < 0.001,I2 = 0%). Moreover, stapes surgery had a significantly shorter duration under LA compared to GA (MD = -8.79, 95% CI [-15.69, -1.88], p = 0.01,I2 = 0%). The meta-analysis on changes in AC, BC, SR thresholds, and ABG showed no significant difference between patients who underwent LA or GA (AC: MD = 0.704, 95% CI [-3.344, 4.752], p = 0.733; BC: MD = 0.191, 95% CI [-2.231, 2.612], p = 0.877; SR: MD = 0.103, 95% CI [-3.621, 3.827], p = 0.957; ABG: MD = 0.451, 95% CI [-0.788, 1.689], p = 0.476). The meta-analysis on ABG closure also showed no significant difference (< 10 dB: OR = 1.066, 95% CI [0.718, 1.582], p = 0.752; 10 to 20 dB: OR = 1.151, 95% CI [0.778, 1.705], p = 0.481; > 20 dB: OR = 0.833, 95% CI [0.537, 1.293], p = 0.416). Complications were the same for both types of anesthesia, but nausea and vomiting showed a marginally significant difference between LA and GA (OR = 2.578, 95% CI [0.988, 6.732], p = 0.053, I2 = 0%). Stapes surgery under LA is associated with shorter surgical and operating room times while demonstrating non-inferior audiometric and safety outcomes compared to GA. These findings suggest that LA represents a safe and efficient alternative to GA for stapesplasty procedures. NA.

Abstract BACKGROUND. Otosclerosis is a common cause of conductive hearing loss in adults, most frequently treated with stapes surgery. However, the factors determining surgical success or failure remain controversial. OBJECTIVE. To identify clinical and surgical variables associated with surgical failure in patients undergoing stapes surgery for otosclerosis at a tertiary referral hospital in northwestern Mexico. MATERIAL AND METHODS. An observational, retrospective, cross-sectional study was conducted on 54 patients diagnosed with otosclerosis who underwent surgery between 2022 and 2024. Adult patients with preoperative and 6-month postoperative audiometry were included, while those without audiological follow-up were excluded. Sociodemographic, clinical, surgical, and audiometric variables were analyzed. Surgical failure was defined as a postoperative air–bone gap (ABG) &gt;10 dB. RESULTS. A total of 81.5% of patients achieved surgical success. No significant association was found between surgical failure and age, sex, comorbidities, smoking status, or the type of surgical visualization used. A higher risk of failure was identified in patients who underwent stapedectomy (OR = 13.6, p = 0.001) and in surgeries performed on the left ear. Hearing improved significantly: the global PTA decreased from 59.8 to 40.1 dB (p&lt;0.001, Cohen’s d=4.5). The ABG decreased across all analyzed frequencies, with large effect sizes. CONCLUSION. Stapes surgery is effective in improving hearing in patients with otosclerosis. Intraoperative decisions, particularly the choice of surgical technique (stapedotomy versus stapedectomy), significantly influence outcomes. These findings support stapedotomy as the preferred technique and highlight the importance of standardized audiometric follow-up.

Background: Stapes prostheses represent one of the earliest and most widely applied “biomedical actuators” designed to restore hearing in patients with otosclerosis. Unlike conventional actuators, which convert energy into motion, stapes prostheses function as passive or smart micro-actuators, transmitting and modulating acoustic energy through the ossicular chain. Objective: This paper provides a comprehensive analysis of stapes prostheses from an engineering and biomedical perspective, emphasizing design principles, materials science, and recent innovations in smart actuators based on shape-memory alloys combined with surgical applicability. Methods: A narrative review of the evolution of stapes prostheses was consolidated by institutional surgical experience. Comparative evaluation focused on materials (Teflon, Fluoroplastic, Titanium, Nitinol) and design solutions (manual crimping, clip-on, heat-activated prostheses). Special attention was given to endoscopic stapes surgery, which highlights the ergonomic and functional requirements of new device designs. Results: Traditional fluoroplastic and titanium pistons provide reliable sound conduction but require manual crimping, with a higher risk of incus necrosis and displacement. Innovative prostheses, particularly those manufactured from nitinol, act as self-crimping actuators activated by heat, improving coupling precision and reducing surgical trauma. Emerging designs, including bucket-handle and malleus pistons, expand applicability to complex or revision cases. Advances in additive manufacturing and middle ear cement fixation offer opportunities for customized, patient-specific actuators. Conclusions: Stapes prostheses have evolved from simple passive pistons to innovative biomedical actuators exploiting shape-memory and biocompatible materials. Future developments in stapes prosthesis design are closely linked to 3D printing technologies. These developments have the potential to enhance acoustic performance, durability, and patient outcomes, thereby bridging the gap between otologic surgery and biomedical engineering.

This multicentric, retrospective study aimed to analyze the safety and effectiveness of the mAXIS Stapes Prosthesis, mLOOP Stapes Prosthesis, mZAM Stapes Prosthesis, and mFIX Stapes Prosthesis. Patients underwent stapes surgery and implantation of a mAXIS Stapes Prosthesis, mLOOP Stapes Prosthesis, mZAM Stapes Prosthesis, or mFIX Stapes Prosthesis (MED-EL, Innsbruck, Austria). The clinical data was retrospectively analyzed. Follow-up examination included access to medical records (for adverse events) of the patients, ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative PTA4 ABG ≤ 20dB was defined as successful rehabilitation. A post-operative minimum and maximum follow-up period was not defined. 189 patients were implanted with a MED-EL stapes prosthesis mainly as treatment of hearing loss caused by otosclerosis. 188 (186 adults, 2 children; 57 conductive hearing loss (CHL), 131 mixed hearing loss (MHL)) patients were examined for adverse events (AEs). 168 (166 adults, 2 children, 51 CHL, 117 MHL) patients underwent audiological examination. Audiology: 110 (65.5%) patients achieved a post-operative PTA4 ABG ≤ 10dB. 154 (91.7%) patients achieved a post-operative PTA4 ABG ≤ 20dB and therefore successful rehabilitation. Individual bone conduction (BC) PTA4 thresholds were stable in 159 (94.6%) patients. AEs: 12 (6.4%, adults only) patients had 13 AEs. Clinical data demonstrated satisfactory audiological results after implantation of the mAXIS Stapes Prosthesis, mLOOP Stapes Prosthesis, mZAM Stapes Prosthesis, and mFIX Stapes Prosthesis. The MED-EL stapes prostheses are safe and effective. NCT05565339 (clinicaltrials.gov).

IntroductionStapes surgery (SS) benefits from adequate anesthetic bleeding control due to its microscopic nature and greater difficulty in hemostasis. Adequate hypotension during intervention is considered critical to achieving this goal.ObjectiveTo evaluate the role of controlled hypotension (CH) on surgical outcomes in SS.MethodsWe conducted a retrospective observational study in a tertiary academic center with adults submitted to SS from January 2017 to October 2022. Hypotension was considered controlled if the mean intraoperative arterial pressure was between 50 and 65 mmHg throughout the procedure. Patients were divided into CH and non-CH groups. Demographic data, medical history, anesthetic and surgical reports, perioperative complications, and audiometry results were studied.ResultsA total of 99 SS procedures were included. Of those, 23 met the criteria for CH. The non-CH group presented a nonsignificant longer operative time (71.4 ± 21.3 versus 83 ± 27.4 minutes;p = 0.065). No statistical difference was observed in complication rates related to the procedure (39.1 vs. 48.7%;p = 0.421). In terms of audiometric data, both groups showed comparable pre- and postoperative pure tone average (PTA) results (preoperative: 55.4 ± 11.3 versus 53.1 ± 16.2dB;p = 0.525; postoperative: 31.6 ± 10.2 versus 33 ± 17dB;p = 0.722). The postoperative average air-bone gap (ABG) was 9.3 ± 8.3 versus 10.1 ± 9dB;p = 0.709, while closure of the ABG was 24 ± 13.1 versus 19.7 ± 17dB;p = 0.287.ConclusionControlled hypotension in SS does not appear to impact the audiometric outcomes or complication rates, despite having a potential role in the surgery duration.

ObjectiveInvestigate the impact of surgical method on hearing outcomes and complication rates after otosclerosis surgery.MethodsRecords of patients more than 18 years old who underwent otosclerosis surgery were reviewed to identify prosthesis type, surgical approach, post-operative dizziness, overnight admissions and hearing outcomes.ResultsA total of 132 stapedotomies were performed with McGee pistons and 144 stapedectomies were performed using ribbon loops. No sensorineural hearing loss was noted with both techniques. Stapedotomy patients had a statistically larger improvement in speech reception thresholds, but there was no significant difference in air–bone gap closure between the two methods. 3.7 per cent of stapedotomy patients experienced post-operative dizziness, which was not significantly different the 7.6 per cent dizzy after stapedectomy (p = 0.2037). Diazepam was prescribed for dizziness in 90.9 per cent (10/11) of dizzy patients with ribbon loops and 0 per cent of those (0/5) with McGee pistons (p = 0.0018).ConclusionBoth approaches yielded similarly good air–bone gap closure and were found to be safe and effective with low post-operative dizziness.

Ear osteotome for scutum removal in stapes surgery

A definitive comparison between endoscopic and microscopic techniques in stapes surgery for otosclerosis patients regarding safety and efficacy, we exclusively included randomized controlled trials (RCTs) and applied the GRADE methodology to assess the certainty of the evidence in our conclusions. A search across PubMed, Web of Science, Scopus, and Cochrane Library was conducted from inception to December 2024. We included only RCTs that compared both techniques of stapes surgery in otosclerosis patients. Primary outcomes were change in air-bone gap (ABG), postoperative ABG, chorda tympani nerve (CTN) manipulation/handling, CTN injury, and postoperative dysgeusia. Secondary outcomes focused on operation time, visibility of incudostapedial complex before suprastructure removal, scutum curettage, postoperative pain and vertigo, hearing improvement, facial nerve injury, tympanic membrane perforation, gusher phenomenon, and tympanomeatal flap tear. Eleven RCTs, with a total of 532 patients, met the inclusion criteria. For mean change in ABG (1.35 [95% CI (-0.22, 2.91)], p = 0.09), postoperative ABG (-0.51 [95% CI (-1.16, 0.14)], p = 0.12), CTN injury, operative time, hearing improvement, and postoperative vertigo, no significant differences were found between both approaches. However, endoscopy was significantly favored over microscopy regarding CTN manipulation RR = 0.63 [95% CI (0.45, 0.88), p < 0.01], postoperative dysgeusia RR = 0.24 [95% CI (0.14, 0.43), p < 0.01], visibility of Incudostapedial complex, scutum curettage, and postoperative pain. Similar auditory results following both techniques of stapes surgery in otosclerosis patients. However, endoscopy seems superior regarding CTN manipulation, scutum curettage, postoperative dysgeusia, and pain.

Outcome of Stapes Surgery in Otosclerotic Patients with Tinnitus

This study investigates hearing outcomes of stapedotomy using two different types of prostheses: manually crimped MatriX and thermally activated NiTiBOND. The primary objective was to determine whether the method of prosthesis fixation to the long process of incus influences postoperative results. A retrospective analysis was conducted on 155 patients with otosclerosis; 90 received the NiTiBOND prosthesis and 65 received the MatriX prosthesis. Choice of prosthesis was determined intraoperatively based on position of chorda tympani. If the nerve was located near the incus and the prosthesis fixation site, the surgeon opted for MatriX prosthesis to avoid potential injury from activation of the NiTiBOND. Audiometric evaluations revealed no statistically significant differences in bone conduction thresholds on the first postoperative day (p = 0.275) or at six weeks (p = 0.899), postoperative air-bone gap (p = 0.810), air-bone gap closure (p = 0.489), overclosure (p = 0.436), or bone conduction at 4 kHz (p = 0.324). Chorda tympani nerve injury occurred in 9.2% of cases with MatriX prosthesis and 6.7% with NiTiBOND prosthesis (p = 0.556). Our findings highlight the theoretical and practical significance of comparing both prostheses, demonstrating that NiTiBOND can serve as an alternative in anatomically favorable cases, thereby guiding treatment choices.

ABSTRACTObjectiveTo evaluate the improvement in bone conduction (BC) thresholds after stapes surgery for otosclerosis, compare the outcomes of surgical techniques, and analyze the short‐ and long‐term results to inform treatment strategies.MethodsWe retrospectively reviewed data from 173 patients (188 ears) who underwent total stapedectomy, partial stapedectomy, or stapedotomy for otosclerosis between 2009 and 2024. Medical histories, preoperative evaluations, and operative records were analyzed, focusing on pre‐ and postoperative pure‐tone audiometry.ResultsPostoperatively, mean thresholds improved by 20.3 dB for air conduction (AC) and 2.0 dB for BC, leading to a mean air‐bone gap (ABG) of 18.3 dB. An ABG of less than 10 dB was achieved in 79 ears (42.0%), and full ABG closure (ABG ≤ 20 dB) was achieved in 145 ears (80.4%). Compared with the preoperative levels, the BC thresholds at 0.5, 1, and 2 kHz improved by 1.3, 3.7, and 4.9 dB, respectively. However, the 4‐kHz BC threshold increased by 1.7 dB. Postoperative AC thresholds at 0.5–4 kHz decreased significantly by 27.1, 26.5, 18.3, and 9.2 dB, respectively (p &lt; 0.001).ConclusionStapes surgery significantly improved BC thresholds at 0.5, 1, and 2 kHz in patients with otosclerosis, with resolution of the CN at 2 kHz, indicating correction of the CHL. Although a slight increase in the BC threshold was observed at 4 kHz, the overall AC threshold improvement and ABG closure were substantial. These findings highlight the clinical relevance of the postoperative BC threshold dynamics.

This study is to evaluate the results obtained in a group of implanted otosclerotic patients and compare them with a matching group of non- otosclerosis cochlear implant patients. Pre-operative computed tomographic scans, intra-operative findings, type of electrode used and difficulties of 17 patients with otosclerosis were documented. Post-operative complications, facial nerve stimulation, electrode dislocation and audiological and speech outcomes were documented and the data analysed. Surgical difficulties were directly related to the advanced stage of the disease. No major complications were reported in this cohort. No significant difference was found between both groups one year after surgery; the mean pure tone average was 35 dB ± 4.43, speech reception threshold was 40 ± 4.96 and speech discrimination score was 80 per cent ± 12.55 in the otosclerotic group. Cochlear implantation is a safe and effective management for advanced otosclerosis patients even after stapes surgery.