Otosclerosis is a prevalent cause of adult-onset progressive hearing loss, typically beginning around the age of 30. This disease is marked by abnormal bone remodeling in the otic capsule, primarily affecting the stapes region, which results in conductive hearing loss. Approximately 10% of patients exhibit sensorineural hearing loss. In 70–80% of cases, it affects both ears, and half of the patients experience tinnitus, while vertigo is reported in 10% of cases. The medical approach to otosclerosis aims to prevent or at least decelerate the progression of the disease. Sodium fluoride and bisphosphonates are the preferred treatments for active lesions to curb the progressively degenerative activity of otospongiosis. Both stapedectomy and stapedotomy are highly successful surgical procedures for addressing the conductive hearing loss caused by otosclerosis. However, stapedotomy has become more popular in recent years due to its superior hearing outcomes at high frequencies and lower complication rates. Stapes surgery can be performed either microscopically or endoscopically. Potential complications of stapes surgery include sensorineural hearing loss, an increase in tinnitus, dizziness, taste disturbance, and in rare cases, facial nerve palsy and deafness.