Otosclerosis is a disease characterized by a pathological bone remodeling process in which normal, dense endochondral bone is replaced by metaplastic spongiosa, in which calcium is deposited. The newly formed irregular and rigid bone fixes the stapes plate in the oval window, resulting in conductive hearing loss. The most effective treatment for otosclerosis is surgical – stapedectomy or stapedotomy. Stapedectomy involves the complete removal of the stapes, followed by the placement of a prosthesis and soft tissue graft. On the other hand, stapedotomy involves creating a small hole in the stapes plate, into which a prosthesis is then inserted. A variety of prostheses are used in stapedotomy, but this review focuses on the Nitinol prosthesis, the Causse Loop Piston prosthesis, and the Big Easy Piston prosthesis, comparing their effectiveness in improving postoperative hearing thresholds. The primary measure of hearing improvement is the air-bone gap (ABG) closure, calculated as the difference between preoperative and postoperative ABG. Based on these values, it was concluded that there is no significant difference in postoperative hearing outcomes among the three compared types of prostheses. The type of surgical approach and the choice of prosthesis must be made according to the individual characteristics of the patient.