Otosclerosis is a focal lesion of unknown origin in the osseous vagus, in which one or several confined, vascularized, spongy new bones are formed within the vagus capsule, replacing the original normal bone. 20-40 years of age is the age of high incidence, with a male to female incidence ratio of 1:2. The etiology is unknown, including the endocrine theory, mostly in women, and pregnancy and menopause can stimulate and aggravate the disease. The genetic theory is that 70% of patients have a family history of otosclerosis, as well as osteogenesis imperfecta of the bone vagus, viral infections, and connective tissue diseases. Clinical manifestations 1. Deafness: slowly progressive conduction deafness or mixed deafness, generally conduction deafness, when it develops to complete fixation of the stapes, hearing tends to stabilize and no longer decline, if the lesion invades the cochlea, it will cause mixed deafness or sensorineural deafness. 2. Tinnitus: often coexists with deafness, mainly buzzing or coaxing low tone low tone, high tone tinnitus suggests cochlear invasion, tinnitus is mostly persistent or intermittent. The lighter cases are felt only in quiet environments, while the heavier ones can make patients irritable and more distressing than tinnitus. 3. Willis Auditory Inversion: In a generally quiet environment, it is difficult to hear and discern language, and in a noisy environment, on the contrary, it is better than in a quiet environment. The occurrence rate is 20%-80%. Once the cochlea is involved, Willis hearing error disappears. 4. Vertigo: Transient vertigo can occur during head movement, the occurrence rate is 5%-25%. Vestibular function can be normal, and vertigo can disappear after surgery in most patients. Because the cause of otosclerosis is not clear, there is no treatment for the cause. Surgery to restore or improve hearing by correcting the sound transmission disorder caused by stapedial fixation is the only effective method at present. Otosclerosis surgery is a difficult otologic procedure for patients with stapedial otosclerosis who have progressive hearing loss due to limited movement or fixation of the stapes due to lesions affecting the circumferential ligament. Otosclerosis surgery is the most exciting and rewarding microsurgery for the otolaryngologist, and complete closure of the air-bone conduction gap at all frequencies after surgery is the ultimate goal of the surgeon. The most commonly used surgical method is the stapes pedicle drilling piston, which has the advantages of good results, stable hearing outcomes over time, and mild postoperative reactions. There are three important factors for a perfect surgical result: 1. precise and meticulous handling during the procedure. 2. measurement, i.e. the distance from the long foot of the anvil to the stapes footplate, from which the depth of the piston pedicle into the vestibule can be determined. The depth of the piston into the vestibule is generally between 0.25 and 0.5 mm [1]. 3, Selection of materials, the selection of a suitable piston for the patient is also a guarantee of the surgical effect. The stability of the piston is also better. In addition, pistons with metal wire hooks (e.g., gold, platinum, pure titanium wire, etc.) can ensure a tight connection between the piston small column and the long foot of the anvil bone, and some studies have shown that a 5-10 dB gap in air-bone conduction often exists in postoperative hearing when the piston small column is not tightly connected to the long foot of the anvil bone. There is also a 5-15 dB difference in postoperative hearing improvement when using a 0.6 mm diameter stapes compared to a 0.3-0.4 mm diameter stapes, but there is no difference when using a 0.6 mm or larger diameter stapes. In order to obtain a perfect surgical result in otosclerosis, the whole surgical procedure should not have the slightest difference, which is a sense of “missing the mark by a hair, but not by a thousand miles”. In recent years, the author has continued to sum up his experience in clinical work and often enjoys the joy of successful surgery. Here I would like to share with you the harmony of the art of surgery and perfect results. A case of otosclerosis stapes surgery with complete data records is presented, and the artistic beauty of the perfect combination of structure and function is demonstrated by some pictures. The patient, female, 43 years old, was preoperatively diagnosed with “bilateral otosclerosis”. The preoperative audiological examination and high-resolution CT of the temporal bone are shown in the figure. The patient underwent a left stapes pedicle drilling piston under local anesthesia + reinforcement. The posterior wall of the external auditory canal was incised at 6 to 12 o’clock in the external auditory canal about 0.8 cm from the tympanic groove, the tympanic flap of the external auditory canal skin was turned up, part of the shield plate was removed with a bone chisel, the stapes tendon and the floor plate were exposed, and the long foot of the anvil and the anvil stirrup joint were found to be intact on exploration, the hammer and anvil were moving well, the stapes floor plate was fixed, the stapes tendon was cut, the anvil stirrup joint was detached with a crochet, and the structures on the stapes floor plate were removed. The distance from the long foot of the anvil to the base plate was measured, and the base plate was drilled with a manual twist drill. 4.25 mm and 0.6 mm pistons were selected for implantation and fixed to the long foot of the anvil after adjustment, and the patient’s hearing was significantly improved by intraoperative whispering test without vertigo symptoms. The earlobe fat tissue was taken to close around the piston to prevent lymphatic leakage, and finally the tympanic flap of the external ear canal skin was reset and the external ear canal was filled with gelatin sponge and iodoform gauze. The stitches were removed 6 days after surgery, and the outer ear canal filling was removed 10 days after surgery. The hearing was rechecked 4 weeks after surgery: the air-bone conduction difference was completely closed at all frequencies.