[Diagnostics and Surgical Therapy of Otosclerosis - Part 2: Indication, Surgical Procedure and Postoperative Treatment].

After approximately 100 years of development and stepwise improvement, stapes surgery is a succesful strategy of managing hearing loss in otosclerosis, although challanges remain. Contraindications include too poor speech understanding (not enough inner ear reserve), and acute or chronic inflammation of the external ear and middle ear. Stapes surgery in the last hearing ear can today be indicated in exceptional cases, especially if the contralateral ear was supplied with a cochlear implant. In case of simultaneous occurrence of pronounced external auditory canal exostoses, a staged procedure may be useful.The surgical principle is to mechanically replace the fixed stapes with a piston-shaped implant under perforation or partial removal of the stapes footplate. Laser-assisted stapes surgery has proven itself in practice and the laser is used regularly today. In regard to revision surgery the increased risk of hearing loss or deafness and vertigo has to be considered. Revisions are made in the event of complications and persistent or newly occurring conductive components. In the case of insufficient hearing rehabilitation, alternative options should be considered, e. g. the combination of a stapes plastic with an active middle ear implant, or a cochlear implant.