Background: The ideal substance to seal the vestibulotomy site after stapes surgery is a topic of debate. Otology surgeons have historically sealed the oval window with a variety of materials. These consist of blood clots, vascular grafts, adipose tissue, gelatin sponge (Gelfoam), and perichondrium.

Objectives: The present work aims to evaluate hearing outcomes and post-operative vestibular symptoms when hyaluronic acid gel (HAG) or gel foam is used as a sealing agent in stapedotomy.

Subjects and methods: This randomized comprehensive clinical trial was performed on 58 patients in Zagazig University hospitals, all complaining of hearing loss. The cases were divided equally into Group (1) hyaluronic acid gel and Group (2) Gelfoam. All study populations were subjected to whole history taking, full ear-nose-throat (ENT) and otoscopic examination, routine laboratory investigations, pure tone and speech audiometry, stapedial reflex, tympanogram, and CT scanning.

Results: Non-significant differences were found between groups for pre and post-operative tinnitus. There was a statistically non-significant variance between both groups regarding pre and post-operative ABG. Statistically significant differences were found between pre- and post-operative vertigo in each group (p<0.001), with non-statistically significant variation between both groups.

Conclusion: This study revealed that using either HAG or Gel foam to seal the stapedotomy, hearing results, and post-operative tinnitus might be the same. However, post-operative vertigo was comparable with the upper hand for HAG to decrease post-operative vertigo. As a result, HAG is advised as a secure sealing, easily used material following otosclerosis stapedotomy