Background: Theoretical disadvantages are associated with the use of heat-crimped piston prostheses in stapedotomy. Loose crimping could result in prosthesis displacement or slippage. Alternatively, overly tight crimping may cause trauma to the incus with resultant necrosis. Objectives: 1) Analyze outcomes of patients undergoing stapedotomy with heat-activated piston-style prostheses, and 2) compare outcomes between prostheses made by different manufacturers. Study Design: Retrospective. Setting: Vanderbilt Medical Center. Patients and Methods: Cases undergoing stapedotomy between 2005 and 2016 were reviewed. Audiometric assessments were recorded in accordance with American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) guidelines. Patients who lacked audiometric follow-up before 6 months or after 1 year were excluded. Intervention(s): Diagnostic, therapeutic, and rehabilitative. Main Outcome Measure(s): Postoperative air-bone gap (ABG) and achievement of an ABG is less than or equal to 10dB. Results: Three hundred fifty-eight patients met inclusion criteria. At short-term follow-up (<6 mo), the mean ABG was 11 8 dB in the entire cohort; this did not differ based on manufacturer (p ¼ 0.13). The majority of patients (63%) achieved an ABG less than or equal to 10 dB. At longer-term follow-up, the mean ABG was 9 7 dB; again no differences were noted when comparing prosthesis manufacturer (p ¼ 0.20). 70% of patients achieved an ABG less than or equal to 10 dB at longer-term follow-up. When comparing short- to long-term follow-up, ABG did not significantly change over time (p ¼ 0.76). The overall revision rate was 1.9% (n ¼ 7). Conclusion: Favorable hearing outcomes are obtained both short- and long-term following stapedotomy and placement of heat-crimped piston prostheses. Both prosthesis groups appear stable in the middle ear environment long-term, as evidenced by a 1.9% revision rate among them.