Educational Objective: The focus of this paper is on the changing patterns of presentation of otosclerosis over the past 37 years, Study Design: Retrospective chart review. Setting: Private otology practice. Patients: Randomized selection of 400 patients (100 per decade) from 15,372 who underwent stapedectomy over the past four decades. Outcome Measures: Extent of cochlear involvement, bilaterality of disease, length of history, degree of hearing loss, and pathological findings are noted. Results: The decreasing incidence of footplates necessitating drillouts is discussed. Changing audiometric patterns at presentation such as decreased pure-tone average hearing thresholds and smaller air-bone gaps are also reviewed. Conclusion: This review demonstrates the changing patterns of presentation of otosclerosis over the past 37 years and will help guide the stapes surgeon into the year 2000.