The aggregate results of the stapedectomy operation for hearing improvement are highly satisfactory in the short and long term when carried out by an experienced and skilled surgeon, using a variety of techniques in carefully selected candidates. An initial bone-air gap of 10 dB or less is achieved in 80-90% of patients. The outcome of stapedectomy is dependent on the patient's level of sensorineural reserve which is age dependent, and on the limitations imposed by stapedial footplate pathology. The advantages of various types of piston prostheses for reconstruction have become increasingly clear. The infrequent complications of immediate and delayed sensorineural losses with impaired speech discrimination are certain to be reduced further in incidence by the increasing adoption of small fenestra techniques with piston prostheses and tissue seals. There is a definite need for fully informative statistical methods in reporting the results of surgery for hearing improvement if further advances are to be made.