Whereas complete removal of the footplate was subsequently replaced by partial platinectomy techniques, the concept of a limited stapedotomy with a 0.4 mm Teflon Platinum piston (TPP) prosthesis revolutionized modern stapes microsurgery. In 1982, the first results of this 0.4-mm stapedotomy technique with the TPP prosthesis were presented and compared to previous stapedectomies. Herein we present the results on 332 consecutive patients undergoing the 0.4mm TPP stapedotomy over a ten year span between the years 1983 to 1993. Closure of the air-bone gap to within 10 dB was achieved in 65% of the cases at 1 year and 66% at 4 years follow up. Within 20 dB, 90% success was observed at 1 year and 89% at 4 years follow up. Complete hearing loss was observed in only a single ear. A drill canal plasty, the presence of an active otosclerotic focus, the occurrence of a footplate fracture, and the eccentric placement of the fenestration all gave rise to poorer hearing gain outcomes. The results of this series are compared to the senior author's previous series and examined with respect to other stapedotomy reports in the literature. New technologies such as the application of the Erbium: YAG laser and titanium prosthesis are discussed.