ABSTRACT
This chapter provides the principles and practicalities of surgery to correct ossicular chain abnormalities with the aim of improving hearing. The majority of ossicular chain defects arise as a consequence of chronic otitis media with or without cholesteatoma. Ossicular chain erosion is much more common in the presence of cholesteatoma. The ideal material for ossicular reconstruction should be biologically stable, of the correct mass and stiffness, be easy to handle, and ideally low cost. There are many options for reconstruction which can be broadly divided into autografts, homografts and alloplastic materials. Autografts are tissues that are harvested from the same patient on which they are to be used, and can include ossicles, cortical bone and cartilage. Selecting an appropriate ossicular replacement prosthesis requires careful consideration of the anatomical configuration of the middle ear and ossicles. The two main options for prosthesis placement are stapes to malleus or stapes to tympanic membrane.
