Expertise for every ear.
A better tomorrow.
Evidence-based ear surgery, second opinions and international knowledge sharing.
Our specialised platforms
Visit our thematic sites for in-depth information and patient support.
What we offer
Clear main sections, each with a short explanation and a path into the detail.
Conditions
Otosclerosis, eardrum perforation, ossicular disorders, cholesteatoma and chronic ear disease.
More information
Treatments
Stapedotomy, tympanoplasty, ossiculoplasty, revision surgery and hearing rehabilitation.
More information
Research
Randomised trials, systematic reviews and outcome research behind the advice.
More information
Education
Plain-English guides for patients and professionals: audiograms, questions, recovery.
More informationSurgery begins with a decision.
Ear surgery should never be an automatic consequence of a diagnosis.
The same problem may sometimes be treated through surgery, hearing rehabilitation, observation or another approach. Which of these is best is not written in the diagnosis; it depends on the ear, on the other ear, and on the person.
The first question is therefore not simply how to operate, but whether intervention offers the best balance of potential benefit and risk.
The right patient.
The right treatment.
The right reason.
A technically successful operation is important. The first responsibility is to make sure it was the right operation, for the right person, for the right reason.
What brings you here?
Choose the situation that fits and start with the pages written for it.
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I have otosclerosis
Understand the condition and compare hearing aids with stapedotomy on equal terms.
Read more -
I have been advised to have ear surgery
The questions to ask before you decide, and how surgical success should be measured.
Read more -
I have hearing loss but no clear diagnosis
Start with the audiogram: what it shows, what it hides, and what to test next.
Read more -
I had previous ear surgery
Why results disappoint, and why revision should begin with revising the diagnosis.
Read more -
I want a second opinion
What a useful second opinion reviews, and how to prepare one.
Read more -
I am a healthcare professional
Clinical summaries, operative principles, audiology and research collaboration.
Read more
Hearing is more than an audiogram.
Pure-tone thresholds measure an important part of hearing — the quietest sounds you can detect at each pitch. They do not measure the whole functional experience: following speech, hearing in noise, knowing where sound comes from, or how tiring it is.
- Speech
- Noise
- Spatial hearing
- Binaural hearing
- Listening effort
- Communication
Two people with similar audiograms can experience very different hearing difficulties.
The ear receives sound.
The brain gives it meaning.
Hearing is both peripheral and central. The auditory system integrates signals from two ears and interacts with attention, memory and cognition. Follow the path a sound takes.
- Sound
- Eardrum
- Ossicles
- Cochlea
- Auditory nerve
- Auditory pathways
- Brain
- Communication
- Sound
- Pressure waves in air, collected by the outer ear and funnelled down the ear canal.
- Eardrum
- A thin membrane that vibrates with sound and turns airborne waves into mechanical movement.
- Ossicles
- Three tiny bones — malleus, incus and stapes — that lever and amplify the vibration into the inner ear.
- Cochlea
- The spiral inner ear where hair cells convert vibration into nerve signals, sorted by pitch.
- Auditory nerve
- A bundle of about 30,000 fibres carrying the coded signal from each ear towards the brainstem.
- Auditory pathways
- Brainstem and midbrain stations where signals from both ears are compared — the basis of binaural hearing.
- Brain
- The auditory cortex and the wider brain, where sound becomes speech, music, direction and meaning.
- Communication
- Understanding a partner in a restaurant, following a meeting, enjoying music — the outcome that matters.
Hearing does not end in the ear.
It becomes meaningful in the brain.
- Binaural hearingtwo ears working as one system
- Speech in noiseseparating a voice from the background
- Spatial hearingknowing where sound comes from
- Localisationtime and level differences between the ears
- Temporal processingfollowing fast changes in speech
- Listening effortthe cost of understanding
- Central adaptationhow the brain adjusts after hearing changes
The description above is deliberately simple. Current understanding of central auditory processing is incomplete, and claims about “training the brain” should be treated with caution.
Personalized ear care
The same diagnosis does not always require the same treatment.
A reasonable decision may depend on:
- Hearing thresholds
- Speech understanding
- Anatomy
- Opposite-ear function
- Binaural hearing
- Age, where relevant
- Occupation
- Lifestyle
- Expectations
- Personal goals
- Risk preference
- Future hearing options
The objective is not to treat an audiogram.
It is to treat a person.
Profile A — hypothetical
- Large air-bone gap, good bone conduction
- Opposite ear hears normally
- Works in meetings, dislikes wearing a device
- Accepts a small risk for a durable result
Stapedotomy is a reasonable option to discuss.
Profile B — hypothetical
- Mixed loss with reduced bone conduction
- Only hearing ear, or opposite ear already operated
- Does well with a hearing aid
- Wants to avoid any risk to inner-ear hearing
Continuing with hearing aids, with observation, is a reasonable option to discuss.
Same diagnosis. Different priorities. Different decisions.
Illustrative profiles only. This website does not provide individual diagnosis or treatment advice.
Preserve what already works.
Improving hearing is important. Protecting hearing that already exists can be equally important — and the two goals sometimes pull in different directions.
Preserve
- Residual hearing
- Cochlear function
- Bone conduction
- Speech understanding
- Future rehabilitation possibilities
hearing
Restore
- Sound transmission
- Middle-ear function
- Hearing access
- Communication
What can we improve — and what must we protect?
Feature condition
Otosclerosis
Otosclerosis is abnormal bone remodelling around the inner ear. Most often it fixes the footplate of the stapes — the third and smallest of the middle-ear bones — so that sound is no longer transmitted efficiently into the cochlea. The result is a conductive hearing loss, usually with normal inner-ear function.
There are two well-established ways to hear better with otosclerosis: amplify the sound with a hearing aid, or restore sound transmission with a stapedotomy. Neither is universally superior.
The decision depends on the hearing itself, the anatomy, the condition of the opposite ear, the person's priorities and lifestyle, and how they weigh a small but real surgical risk against a durable result without a device.
otosclerose.nl is the independent patient resource on otosclerosis, in English and Dutch, with an audiogram simulator and a printable question list for your ENT surgeon.
Hearing aid
- No surgical risk to inner-ear hearing
- Adjustable as hearing changes
- Device dependence; daily use, batteries, upkeep
- Amplifies, but does not restore natural transmission
Stapedotomy
- Closes the air-bone gap in most suitable ears
- Often no device needed afterwards
- Small risk of worse inner-ear hearing, dizziness, taste change
- Results can change over years; revision is sometimes needed
Both remain reasonable choices. The comparison page sets them side by side without a thumb on the scale.
Ear surgery
What each operation is for, what it can realistically achieve, and where it cannot help. Education, assessment, second opinion, treatment and referral are different things; the pages make clear which is which.
Stapedotomy
Small-fenestra stapes surgery for otosclerosis: objectives, air-bone gap, risks and recovery.
Read moreTympanoplasty
Eardrum repair — a safe, dry ear and better hearing are related but separate goals.
Read moreOssiculoplasty
Reconstructing the chain of three small bones when it is eroded, fixed or interrupted.
Read moreRevision ear surgery
Revision begins with revision of the diagnosis.
Read moreCholesteatoma
Skin growth in the middle ear: why a safe ear comes first.
Read moreHearing rehabilitation
Hearing aids, bone-conduction devices and implants — often the right answer.
Read moreSome procedures are described here for educational purposes. Where a procedure is discussed but not personally offered, the page says so and points to appropriate referral.
Diagnosis
Audiometry
Imaging
Surgical indication
Expected benefit
Alternatives
Previous surgery
Hearing preservation
Revision strategy
Better decisions start with better understanding.
Practical answers to the questions people ask before and after ear surgery, written in plain English with a technical layer for those who want it.
Evidence matters.
Clinical experience, anatomy, audiology, scientific evidence and patient priorities should reinforce each other. Where they conflict, the conflict itself is information.
The research behind this platform comprises six randomised trial programmes in otology — bilateral cochlear implantation, single-sided deafness, day-case ear surgery, hearing protection — laboratory work on stapes-surgery lasers and inner-ear imaging, and 49 systematic reviews. The complete, dated record is at orl.nl.
Research themesResearch themes
- Otosclerosis
- Stapes surgery
- Hearing preservation
- Binaural hearing
- Cochlear implantation
- Clinical trials
- Hearing outcomes
- Systematic reviews
- Telemedicine
- Education
What studies show
Where evidence is consistent, pages say so plainly.
What remains uncertain
Heterogeneous or thin evidence is labelled as such.
What this means in practice
Every evidence box ends with the practical implication.
Hearing · Connects · People
A better tomorrow.