Otosclerosis is a hereditary disease which results in progressive stiffness of the stapes bone, the third of the three middle ear bones. As the stapes bone becomes progressively stiff it transmits sound energy less efficiently through the middle ear resulting in conductive hearing loss. What is so exciting about otosclerosis is that the middle ear component of the hearing loss is treatable by surgery generally called stapedectomy. The principle of this operation is to restore sound transmission to the inner ear bypassing the fixed stapes bone. This can be achieved either by removing the entire stapes bone (stapedectomy) or drilling a very fine hole through it (stapedotomy) and replacing it with an artificial stapes bone. When stapes operations were first developed in the 1950s, it was necessary to remove the whole stapes bone before introducing an artificial stapes replacement (generally made of fine stainless steel wire and fat taken from the ear lobe).
As the micro drills, and more recently lasers, were developed it became possible to drill a fine hole (less than 1 mm in diameter) through the stapes footplate and introduce a replacement stapes bone (made of titanium/ platinum and Teflon) to effectively bypass the fixed bone, leaving the remaining footplate largely intact. Both operations in skilled hands produced wonderful hearing results, and both operations still carry similar risks of permanent and severe hearing loss (dead ear, less than 0.5%). However, the stapedotomy operation produces less trauma to the inner ear, preserving the higher hearing frequencies. The modern stapedotomy replacement bones are also safer to revise if necessary and the replacement prosthesis is compatible with MRI (magnetic resonance imaging) scanners if imaging of the region is required later on. Because of these advantages, all modern stapes surgery for otosclerotic hearing loss is in the form of stapedotomy.