Otosclerosis is a very high prevalence disease in the West and many otologists rely on otosclerosis surgery for their livelihood. The incidence of otosclerosis is significantly lower in China and the yellow population than in the West, but it is still a common otologic disease relative to the population base. Its main manifestation is progressive bilateral hearing loss, and it has a relatively young age of onset, which has a significant impact on the patient’s quality of life. If the lesion invades the vestibular window niche, the cricoid ligament and the stapes, the stapes activity is limited or disappears, which is called stapedial otosclerosis. If the lesion occurs in the cochlear window, cochlear canal, semicircular canal and the bone wall of the internal auditory canal, the vascular pattern and sensory hair cells may be damaged and vertigo and sensorineural deafness may occur. The clinical manifestations are: 1. Hearing loss: slowly progressive, asymmetric hearing loss in both ears with no obvious cause and mostly without a history of chronic otitis media. The self-talk is small due to enhanced self-hearing. In addition, patients have Wechsler’s mishearing, a phenomenon in which patients feel their hearing improves in noisy environments. 2.Tinnitus: About half of the patients have tinnitus, which is usually mild. 3. Vertigo: Patients with cochlear otosclerosis may develop vertigo, which often manifests as recurrent episodes of vertigo or balance disorders. Otoscopic examination: The tympanic membrane is intact and normally marked. In some patients, a translucent red area in the posterior upper quadrant is visible, which is a reflection of mucosal congestion in the tympanic capsule area, called Schwartze’s sign, suggesting that otosclerosis is in an active stage. Pure tone audiometry: The audiogram shows mild to moderate conductive deafness, and the degree of hearing loss is related to the stage of otosclerosis. There may be a 10-30 dB drop in bone conduction at 2 kHz, called the Carhart notch, which is caused by stapes fixation. The tympanogram and sound compliance values are normal, the stapedial muscle reflex cannot be elicited, and the eustachian tube is functioning well. In advanced cases of otosclerosis, thickening of the stapes floor and irregularity of the bone shadow of the vagus capsule can be observed. The main purpose of surgery is to improve hearing, and the main surgical procedure is stapes implantation, in which a CO2 laser is used to create a hole in the stapes plate and implant an artificial stapes to regain a normal middle ear sound transmission system. For those who have contraindications to surgery or refuse surgical treatment, they can be treated with hearing aids or sodium fluoride medication.