Objectives To analyze health-related quality of life (HRQoL) and audiological results after stapes surgery using a Nitinol Head Prosthesis (NHP). Methods Study - Design Prospective longitudinal study. Patients Patients undergoing stapes surgery for otosclerosis and stapes reconstruction with a NHP between January 2018 and December 2018 ( n  = 48). Intervention Audiological measurements preoperatively and at 6 months follow-up as well as two questionnaires assessing HRQoL, i.e., the Stapes Plasty Outcome Test 25 (SPOT-25) and the Glasgow Benefit Inventory (GBI). Main outcome measures Correlation of pure tone average (4PTA 0.5–3 kHz) with questionnaires assessing HrQOL preoperatively and at follow-up after stapes surgery. Results Patients showed a significantly reduced air–bone–gap (ABG, 0.5, 1, 2, 3 kHz) at the follow up visit (median: 11.3 dB, IQR 5.0–14.4) compared to the preoperative measurements (median 27.5 dB, IQR 21.9–36.3). Disease-specific HRQoL improved significantly in all scales of the SPOT-25 apart from the subscore “tinnitus”. Postoperatively, the subscore “hearing function” correlated well only with the ABG ( r  = 0.59, p  = 0.001). The SPOT-25 and GBI total scores showed a moderate negative correlation ( r  = − 0.59, p  = 0.008). Conclusions Stapes surgery leads to significant improvements of hearing and the HRQoL. However, correlations between HRQoL questionnaire scores and the audiometric outcomes were inconclusive, indicating that the use of HRQoL measures for the assessment of stapedotomy outcomes to complement objective outcomes should be encouraged.