The postoperative results in 392 otosclerotic ears were analyzed. Stapedotomy with wire Teflon piston does not increase the risk of postoperative fistula formation in comparison to stapedectomy with tissue graft sealing. Stapedotomy with a 0.4 mm wire Teflon piston yields poorer results in the lower frequencies 3 weeks postoperatively but results as good as those of 0.6 mm stapedotomy at 3 months and 1 year follow-up. The advantage of 0.4 mm stapedotomy is to permit creation of the desired fenestra into the footplate and placement of the prosthesis before violating the integrity of the incudostapedial joint and of the stapedial arch. Stapedotomy with the 0.4 mm wire Teflon piston is the operation of choice for otosclerosis, since it is less traumatic to the inner ear and achieves better results than stapedectomy.