ossiculoplasty

Ossiculoplasty is a middle-ear surgical procedure aimed at repairing the ossicular chain—the malleus, incus, and stapes—to restore sound conduction and improve conductive hearing loss. The operation is performed by otologic surgeons using microsurgical techniques under anesthesia.

Indications include conductive hearing loss caused by ossicular disruption or fixation, such as otosclerosis, erosion from chronic otitis media or cholesteatoma, or damage from prior ear surgery. A functioning tympanic membrane and healthy middle-ear mucosa are important factors predicting a favorable outcome.

Techniques used in ossiculoplasty vary by pathology. Stapedotomy or stapedectomy with placement of a piston prosthesis is common for otosclerosis. Reconstruction of the ossicular chain with partial or total prostheses, known as PORP (partial ossicular replacement prosthesis) and TORP (total ossicular replacement prosthesis), bridges gaps between the tympanic membrane or malleus and the inner ear. Prosthetic devices are often made of titanium or other biocompatible materials and may be coupled to the tympanic membrane, malleus, or the stapes footplate or oval window. Procedures may be performed via endaural or postauricular approaches.

Outcomes and risks: The aim is to reduce the air–bone gap and improve hearing; success rates depend on the underlying disease and technique, but measurable improvement is reported in many patients. Potential complications include sensorineural hearing loss, vertigo, tinnitus, prosthesis extrusion or dislocation, infection, and persistent conductive loss. Postoperative audiology testing guides further management.

Follow-up and alternatives: Ongoing evaluation with audiometry assesses gain and device function. If reconstruction is not feasible or effective, alternatives include conventional hearing aids or bone-anchored hearing systems.