Massimilla EA, Testa D, Nunziata M, et al. - In this retrospective clinical study, researchers described their experience with long process incus (LPI) necrosis in revision stapedotomy and addressed the various management methods proposed in the literature to identify surgical techniques that can lead to satisfactory outcomes over time. Between 1997 and 2017, 22 stapedotomy revisions were performed in 21 patients with the necrosis of the long process of the incus. Postoperative ABG was reduced to ≤ 10 dB in 13 (59%) cases and ≤ 20 dB in 19 (86.4%) cases at 1-year follow-up. In cases of long incus process necrosis, excellent functional results can also be achieved. It is necessary to consider the choice of technique according to the degree of necrosis. Excellent hearing results were obtained by piston replacement with the same type or angled type prosthesis, in cases of erosion or minimal LPI necrosis, and modified Donaldson type ventilation tube, in cases of partial LPI necrosis.