Since the 1960s, our group has performed more than 18,000 primary and revision stapedectomies for the treatment of otosclerosis. All of the patient histories, surgical findings, and hearing results pertinent to these cases have been entered into a database at our clinic. The suggestions and conclusions that we offer in this and in future installments of Clinical Nuggets are based on, and thus validated by, the experience that has been documented in our database. We begin with some pearls on the presentation and diagnosis of otosclerosis. In future installments, we will provide some tips on the physical examination and on primary and revision stapedectomy. Our goal is to give you a clear picture of what works and what doesn't.