Skip to main content

Featured post

Paediatric ENT Problems: When Should Your Child See an ENT Specialist?

  Common Paediatric ENT Problems: When Should Your Child See an ENT Specialist? Ear, nose and throat (ENT) problems are extremely common in children. Many improve naturally over time, but some symptoms may begin affecting sleep, hearing, speech development, school performance or overall quality of life. Parents often feel unsure about when repeated infections, snoring or hearing concerns require specialist assessment. This guide explains some of the most common paediatric ENT conditions and when referral to an ENT specialist may be helpful. Common childhood ENT conditions Children frequently experience: Recurrent tonsillitis Enlarged tonsils or adenoids Snoring and disturbed sleep Glue ear Recurrent ear infections Hearing concerns Persistent nasal blockage Speech delay related to hearing problems Some conditions improve with time, while others may benefit from medical or surgical treatment. Recurrent tonsillitis in children Repeated throat infections can...

Ossiculoplasty Surgery - Restoring Your Hearing

 


Ossicular Reconstruction (Ossiculoplasty)

Patient Information Leaflet

1. Why am I being offered ossicular reconstruction?

You have hearing loss caused by damage or disruption to the ossicles — the three tiny bones in the middle ear (malleus, incus, and stapes) that transmit sound from the eardrum to the inner ear.

This damage may be due to:

  • Chronic ear infections

  • Cholesteatoma

  • Previous ear surgery

  • Long-standing eardrum perforation

  • Trauma or erosion of the hearing bones

Ossicular reconstruction (ossiculoplasty) is a surgical procedure designed to improve hearing by rebuilding this sound-conduction mechanism.

2. What is ossicular reconstruction?

Ossiculoplasty involves repairing or replacing one or more of the hearing bones using either:

  • Your own tissue (e.g. reshaped ossicles or cartilage), or

  • A biocompatible prosthesis (most commonly titanium)

The operation is usually performed alongside:

  • Eardrum repair (tympanoplasty), and/or

  • Mastoid surgery (especially if cholesteatoma is present)

The exact technique depends on what ossicles are present and mobile at the time of surgery.

3. Types of ossicular reconstruction

Depending on what remains of your natural hearing bones, your surgeon may use:

🔹 Partial Ossicular Replacement Prosthesis (PORP)

  • Used when the stapes (inner bone) is intact

  • Generally associated with more reliable hearing improvement

🔹 Total Ossicular Replacement Prosthesis (TORP)

  • Used when only the stapes footplate remains

  • Hearing improvement is still possible, but results are less predictable

Your surgeon will explain which option is most appropriate for your ear.

4. What are the expected benefits?

The main goal is to improve conductive hearing loss.

  • Many patients experience meaningful hearing improvement

  • Some patients may only have partial improvement

  • In a small number of cases, hearing may remain unchanged

Importantly:

  • Surgery cannot guarantee normal hearing

  • Results depend heavily on the condition of the middle ear

Modern studies show that partial reconstructions tend to yield better, more stable hearing outcomes than total reconstructions, especially when middle-ear disease is limited.


5. Factors that affect hearing outcome (important for shared decision-making)

Your surgeon will discuss factors that influence success, including:

  • Presence of a healthy stapes and malleus

  • Eustachian tube function (pressure regulation in the ear)

  • Ongoing or previous infection

  • Presence or history of cholesteatoma

  • Whether mastoid surgery is required

  • Smoking (associated with higher complication rates)

These factors help explain why outcomes vary between patients, even with the same operation


6. What are the alternatives to surgery?

In keeping with Montgomery principles, you should be aware of reasonable alternatives, including:

  • Hearing aids (often very effective and non-invasive)

  • Ongoing observation if symptoms are mild

  • Further medical management if infection or inflammation persists

  • Bone-conduction hearing devices (in selected cases)

You are not obliged to proceed with surgery, and choosing a non-surgical option will not compromise your future care.

7. What are the risks and possible complications?

All surgery carries risks. While ossiculoplasty is generally safe, it is important you understand material risks that may matter to you personally.

Hearing-related risks

  • No improvement in hearing

  • Partial or fluctuating improvement

  • Worsening of hearing (rare)

  • Need for revision surgery

Prosthesis-related risks

  • Displacement or extrusion of the prosthesis

    • Modern extrusion rates are approximately 4–5%

    • Risk is reduced by using cartilage protection and careful placement 

Infection

  • Early infection: ~1–2%

  • Delayed or persistent discharge: higher in ears with chronic disease

Facial nerve weakness

  • Very rare

  • Usually temporary if it occurs

  • Permanent weakness is exceptionally uncommon

Other rare risks

  • Dizziness or imbalance

  • Tinnitus

  • Altered taste on one side of the tongue

  • Need for further surgery months or years later

Your individual risk profile may differ depending on your ear condition, and this should be explicitly discussed with you.

8. What happens during and after surgery?

During surgery

  • Performed under general anaesthetic

  • Usually lasts 1–2 hours

  • Often combined with eardrum repair

After surgery

  • Ear packing is placed and removed later

  • Hearing initially may be worse due to packing

  • Hearing is formally assessed after healing (usually 6–12 weeks)

You may be advised:

  • Not to blow your nose forcefully

  • To keep the ear dry

  • To avoid flying or heavy exertion for a short period (6 weeks)

9. Will I need further surgery?

  • Most patients do not need further surgery

  • Revision surgery may be required if:

    • The prosthesis moves or extrudes

    • Infection persists

    • Hearing outcome is unsatisfactory

Long-term studies suggest revision rates range from 5–25% over several years, particularly in ears with severe underlying disease.


10. Shared decision-making and consent

Your surgeon will:

  • Explain your diagnosis, treatment options, and alternatives

  • Discuss benefits and risks relevant to you

  • Answer your questions honestly

  • Support you in making a decision aligned with your values and priorities

You are encouraged to:

  • Take time to consider your options

  • Ask questions

  • Involve family or carers if you wish

Consent is an ongoing process, not a single signature.

11. When should I seek medical advice after surgery?

Contact your ENT team urgently if you experience:

  • Severe or worsening pain

  • Increasing discharge or swelling

  • New facial weakness

  • Sudden dizziness or hearing loss

  • Fever or signs of infection

12. Key take-home messages

  • Ossicular reconstruction aims to improve hearing, not guarantee normal hearing

  • Results depend on the health of the middle ear

  • Partial reconstructions generally have more predictable outcomes

  • Risks are low but not zero

  • Non-surgical alternatives are valid and effective

  • The decision should be shared, informed, and personalised



Mr Gaurav Kumar
Consultant Ear Nose Throat Surgeon

Book appointment
07494914140



Popular Post

Coblation Tonsillectomy

Hi Guys, Let us talk about your tonsils and adenoids. Tonsils and adenoids are part of the immune system and help fight germs. Sometimes these tissues become infected and is called tonsillitis. When you have tonsillitis, you can feel sore to eat and drink, have the temperature, and can even have difficulty in breathing. This can be treated by a procedure called Tonsillectomy. Mr Kumar may advise you to have your tonsils removed if you have tonsil stones, if your airway is blocked due to large tonsils making you choke at night ie sleep apnoea or one tonsil is bigger than other. Tonsillectomy can be done by the traditional techniques using cold steel, electrocautery or coblation.  Cold steel and elctrocautery has moderate to severe pain in postoperative period. With new coblation technique, post operative pain is very low leading to quicker recovery.  Coblation is an advanced technology that combines gentle radiofrequency energy with natural saline — to quickly, and safely r...
Read more

After your Epley manoeuvre — patient information leaflet

  What this leaflet tells you This leaflet explains what to expect after the Epley (canalith repositioning) manoeuvre for posterior-canal BPPV, what you should and shouldn’t do, and when to seek help.   1. Quick summary — what the Epley did The manoeuvre moves tiny particles (otoconia) out of the balance canal of your inner ear and back into a place where they don’t cause spinning (vertigo). Most people feel much better after one or a few treatments. However BPPV can come back (recurrence is common).   2. How you may feel immediately afterwards You may feel dizzy or off-balance for a few minutes to a few hours; nausea is possible.   Some people feel better straightaway; others get gradual improvement over days.   Rarely ,you may have brief recurrences of vertigo — this does not always mean the manoeuvre failed.   3. Activity and posture — what the evidence says Good news: High-quality studies and recent guidelines show that strict he...
Read more

"Naseptin: Powerful Defence Against Nasal Bacteria!"

  Everything You Need to Know About Using Naseptin Nasal Cream   If you've been dealing with nasal issues, you may have come across Naseptin nasal cream as a potential solution. Whether you suffer from recurrent nasal infections (vestibulitis), nose bleeds or simply need some relief from nasal dryness, Naseptin can be a valuable aid. In this blog, we'll cover everything you need to know about using Naseptin nasal cream to ensure you get the best results from this trusted product.   Unlocking the Power of Naseptin Nasal Cream: A Guide to Its Versatile Uses   Naseptin nasal cream, a powerful ally in nasal health, holds the key to treating infections caused by staphylococcal bacteria. This versatile cream offers much more than meets the eye, and we're here to shed light on its incredible benefits! 🌟 👃 Kicking Nose Infections to the Curb: Say goodbye to those troublesome nose infections! Naseptin comes to the rescue, targeting staphylococcal bacteria and...
Read more

Earbuds vs Over-Ears: Which One Is Silently Damaging Your Hearing?

Headphones are no longer an occasional accessory—they’re part of daily life. From early-morning podcasts to late-night playlists, our ears are spending more time under acoustic load than ever before. But a question keeps coming up in clinics, classrooms, and conversations around ear health: Are earbuds worse for your hearing than over-ear headphones? Let’s move beyond opinion and aesthetics. By looking at sound pressure levels , hygiene , and long-term listening behaviour , we can reach a clear, evidence-informed conclusion. 1. Sound Pressure Levels: Distance Matters More Than You Think The single most important factor in headphone-related hearing risk is the amount of sound energy that  reaches the inner ear . Earbuds (In-Ear Headphones) Sit millimetres from the eardrum Deliver sound directly into the ear canal Require lower absolute power , but often result in higher sound pressure at the cochlea Users tend to increase volume in noisy environments (commuting, g...
Read more

Do I need nasal valve collapse surgery?

  What is the nasal valve area in the nose? The nose is a non-uniform tubular structure from the inside. The narrowest points are the entry point, the nostrils, and the exit point at the nose's back. As the nasal valve is the narrowest point, it plays a critical role in how we breathe. The nasal valve area is the internal nose area we can view without instruments when we look in the mirror with the head tilted back. Why is the nasal valve important in breathing through the nose? Airflow in the nasal valve area follows Bernoulli's principle. When the airflow increases, the pressure falls and pulls the side walls with it. This is very similar to when a fast train pulls the air around it with it. As a result, people on the platform are advised to stand clear because there is a risk of getting pulled in. How do I test if I have nasal valve collapse? Nasal valve problems can be due to bent septum or weak cartilages in the nose's sidewall. Using Breathe Easy Strips can give you a...
Read more

Is Ear Wax Removal Safe?

  What is ear wax? The ear canal has two zones, outer ear canal lined by skin having hair and sweat glands and inner ear canal containing only skin covering bone next to eardrum. Earwax, medically known as cerumen, is a mixture of sweat, secretions from the sebaceous gland and dead cells. Therefore, the amount of secretions you have in your ear wax can be of two major types, wet ear wax and dry ear wax. Why do some people have more ear wax problems/ build-up? The first thing to know is everyone makes wax, and some naturally more and some less. Secondly, the shape of the ear canal can predispose you to have more earwax problems. You may have a hairy ear canal or narrow ear canal, which can trap more than the usual amount of ear wax you produce. Thirdly, if produce ear wax which gets stuck to the ear canal, it becomes difficult to fall out. Some people may push ear wax in if they are using insert headphones, i.e. earpods, earplugs for noise reduction or swimming/hearing aids. What ar...
Read more

Superior Canal Dehiscence Syndrome (SCDS)

🔍 Unlocking the Mystery of Superior Canal Dehiscence Syndrome (SCDS) 🌀✨ It's a rare condition that affects the inner ear, and here's the lowdown:   Cause: SCDS occurs when one of the bony canals in the inner ear, particularly the uppermost semicircular canal, doesn't close or thicken properly during fetal development.   Symptoms:   Hearing Loss: It's a common symptom of SCDS. Sound Distortion: Ever feel like sounds aren't quite right? That could be SCDS at play. Balance Problems: SCDS can throw your balance off, making you feel unsteady. Autophony: Imagine hearing your own heartbeat or breathing louder than usual. That's autophony. World Tumbling Sensation: Loud noises or pressure changes might make you feel like the world is spinning. Diagnosis and Treatment:   CT Scans: A specialist might use these to spot SCDS, but other tests are crucial too. Hearing Tests: Essential for accurate diagnosis. Treatment: Surgery may be necessary for severe symptoms. ...
Read more

"Exploring Post-Grommet Complications: What You Need to Know"

 Navigating Postoperative Complications of Grommet Insertion: A Comprehensive Guide Grommet insertion, a standard surgical procedure to alleviate symptoms of middle ear disorders, can sometimes be accompanied by postoperative complications. Among these, one of the most frequently encountered issues is otorrhea or ear discharge. Understanding the nature of postoperative complications and their management is crucial for patients and healthcare providers. Types of Otorrhea Postoperative otorrhea manifests in various forms, including early, delayed, chronic, and recurrent. Early otorrhea occurs within four weeks of surgery, while delayed otorrhea surfaces four or more weeks post-surgery. Chronic otorrhea persists for three months or longer, while recurrent otorrhea involves three or more discrete episodes. Studies suggest that ear discharge after grommet insertion affects a significant proportion of patients, with rates varying from 16% to as high as 80%. Prophylactic Measures and Trea...
Read more

Hoarseness or change in voice...

When should I get worried about my change in voice? Change in voice can be due to so many causes. It can be due to simple things like acid reflux, chronic cough, flu, post nasal drip leading to frequent throat clearing or due to cancer on the voice box.  "IF YOU HAVE CHANGE IN VOICE WHICH IS GETTING WORSE FOR MORE THAN 3 WEEKS, YOU NEED TO SEE AN ENT SURGEON." Other symptoms which can be present with a change in voice in cases of laryngeal cancer be weight loss when you are not dieting, a lump in the throat, earache, shortness of breath, throat pain. How does the ENT surgeon diagnose what is causing my hoarseness? Change is voice can be due to both non-cancer and cancerous reasons. On a visit to ENT voice specialist, he or she will take a full detailed history, access how your profession is affecting your voice and how voice change is affecting your job. After recording your quality of sound, an endoscope (a thin tube with a camera attached) is used to ...
Read more

“Where Are Your Tonsils? Your Health’s First Line of Defence!”

  Where Are Your Tonsils Located?   Learn About Their Position and Importance for Your Health Have you ever wondered where your tonsils are and why their location is significant for your health? Let's explore the fascinating world of tonsils and understand their crucial role in your body's defence system. What Are Tonsils? Tonsils are two oval-shaped masses of lymphoid tissue located at the back of your throat. They are part of your immune system, which is a complex network of cells, tissues, and organs that work together to defend the body against harmful invaders. The tonsils are vital in protecting your body from infections. They are often referred to as the "first line of defence" because they are strategically positioned to catch and filter out germs that enter through your mouth or nose. Where Exactly Are They Located? Your tonsils are situated in the pharynx, just behind the soft palate. There are two tonsils, one on each side of your throat. If you open your ...
Read more