A young woman hears better in noisy rooms — otosclerosis; stapedotomy restores hearing. Otosclerosis (abnormal bone fixes the stapes footplate — progressive conductive loss, young women, paracusis willisii — better in noise, Carhart's notch on audiometry): stapedotomy (laser hole + piston prosthesis) restores conduction dramatically — patients hear the room wake up. Facial nerve (long middle-ear course — dehiscent; at risk in mastoid surgery/trauma; Bell's palsy — LMN: steroids + eye protection). Tumors — glomus (vascular middle ear — pulsatile tinnitus, bleeding polyp), acoustic neuroma (CN VIII — unilateral SNHL + tinnitus; MRI). The noise-paradox is the clue — better in noise means conductive.