This book reflects the personal experience of a surgeon through three and one-half decades of stapes surgery. As such, it shows how surgery has evolved from large to small fenestra, with use of the microdrill replacing picks, and the advent of laser stapedotomy.

The text is divided into 38 ‘chapters’, which vary in length from a very brief half of one page for some quite important topics (e.g. otosclerosis and vertigo, pre-operative counselling, indications for a hearing aid) to appropriately lengthy coverage of the use of the microdrill or problems during stapedectomy. There is very good coverage of every possible technique that has been employed to get that piston into the oval window, and the tips and pearls of wisdom offered do reflect a profound experience.

There was some novelty for this retired otologist. Securing a loose piston by interposing the chorda tympani next to the incus log process, within the loop, is tricky. Reconstruction of the stapedius tendon by attaching it to the incus may be well established, but it was new to me. I liked the repeated warning of the risk of a perilymph ‘gusher’ in what is thought (wrongly) to be a congenitally fixed stapes in children. Even more impressive, but rarely addressed, is the concern about the bilateral Rinne test result, where one may be a false negative. Three times in the book, caution is advised, but perhaps without fully expressing the real risk. Guided by the Weber test, which is, ‘surely it is’, indicating the side with the greater conductive loss, the surgeon may inadvertently be instead operating on the only-hearing ear.

The colour photography throughout is of commendable quality (actually it is quite remarkable at times) for what is a challenging subject. Some of the images of an abnormal course for the facila nerve, or a stapedial artery, are impressively cautionary. I would like to have seen some of the comments and recommendations backed by some citation to the literature, but references are totally absent here.

With many very short chapters, there is much blank paper, but the layout actually made for very easy reading. The author has a gift for succinct writing and a pleasing style in presenting some very helpful advice for anyone starting out on that learning curve.