Objective To investigate the anatomic relationship between utricle, saccule, and stapes footplate, and adapt the stapes prosthesis tip to reduce postoperative vertigo. Study design Five temporal bones were serially sectioned and stained, and the distance from the inner lining of stapes footplate to saccule and utricle, respectively, were measured. The Fisch prosthesis was modified with a slope of 45 degrees at its tip to adapt to the anatomic configuration of the vestibule. Fisch’s original piston or the modified piston was used in 174 ears (Group I) and 108 ears (Group II), randomly. Results There was no statistically significant difference in hearing improvement between the 2 groups ( P > 0.5). However, postoperative vertigo was significantly reduced when the modified prosthesis was inserted ( P < 0.005). Conclusions The modified piston improved the hearing to the level of the original piston, and the incidence of postoperative vertigo was significantly decreased. Significance A modified prosthesis is presented for a patient undergoing stapedotomy.