Stapedotomy produces the best hearing results of any otological operation. However, in a small number of cases the air–bone gap is not successfully closed, or conductive hearing loss recurs.

To investigate the proportion of cases in the senior author's series which required revision surgery and to determine the medium to long term success rate of surgery, taking into account the results of revision surgery.

Review of a series of 233 primary stapedotomy operations and 100 revision procedures carried out by one surgeon over a 20-year period.

Closure of the air–bone gap to within 10 dB was achieved in 80 per cent of cases following the primary procedure. Fifteen per cent of patients developed a recurrence of conductive hearing loss. When the results of revision surgery were taken into account, the proportion of ears with a mean air–bone gap of less than 10 dB was 86 per cent. However, of the patients undergoing revision surgery, air–bone gap closure to within 10 dB was only achieved in 52 per cent of cases.

The best chance of obtaining a successful outcome in stapedotomy is to achieve this for the first procedure. However, revision surgery does increase the medium to long term success rate.