Skip to main content

Featured post

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 i...

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

Boil in the Ear canal can be very painful...

How do I know I have boil in the ear canal? The ear canal is lined by skin up to the eardrum. Skin in the outer third of the ear canal has hair follicles. Hair follicles can get infected with bacteria and can form boil or furunculosis. It is challenging to look in our own ear canal. You can only feel a bump in the ear canal entrance which is tender to touch. Why is so painful when we have boil in the ear? Ear canal skin is very tightly attached to underlying cartilage. So any swelling in the skin stretches it and makes it very sore to touch. How do we get boil in the ear canal?  Most common causes of boil in the canal is dryness of the skin and trauma. Dry skin leads to cracks and these cracks can get infected. People who use dry earbuds, fingers, towel edges or pens and traumatise ear canal skin, which can get infected with bacteria. How do I release the temptation of using earbuds? Some people can get very dry skin due to sensitivity to soup, shampoo o...
Read more

Bleeding From Ears

  Why is my Q-tip bleeding from my ear?   It can be alarming if you've ever noticed blood on your Q-tip after cleaning your ears. Here are a few reasons why this might happen:   🚫 Avoid Inserting Q-tips Too Deep: The most common cause of bleeding is inserting Q-tips too far into the ear canal. This can lead to irritation, scratches, or even damage to the delicate ear tissues.   🩹 Ear Injuries or Scratches: Vigorous or improper cleaning can cause small injuries or scratches inside the ear canal. These injuries may result in bleeding when you use a Q-tip.   🩸 Ear Infections: Infections like otitis externa or swimmer's ear can make the ear canal more sensitive. Cleaning during an active infection can cause bleeding.   🔄 Wax Impaction: Excessive earwax can cause blockages, leading to a feeling of fullness and impaired hearing. Attempting to clean it out with a Q-tip may cause bleeding, especially if the wax is impacted.   👂 What to Do...
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

What are different types of nasal sprays?

Nasal sprays are a popular form of medication for treating nasal allergy symptoms. They are sprayed directly into the nose to target the symptoms without affecting the rest of the body. There are many types of nasal sprays available, both prescription and over-the-counter. Here is a quick guide to the different types: Nasal Steroid Sprays: These are usually one of the first-line allergy therapies. They decrease inflammation within the nasal passages and relieve nasal congestion, sneezing, watery eyes, and runny nose. Many of these sprays are available over the counter. Some common generic and brand names include Budesonide, Ciclesonide, Fluticasone, Flunisolide, Mometasone, Rhinocort, Omnaris, Zetonna, Flonase, Nasonex, Nasacort, Xhance, Beconase, Nasarel, Qnasl, Vancenase, Veramyst, and Zetonna Nasal Decongestant Sprays: These sprays temporarily relieve nasal congestion by constricting the blood vessels in the nose, reducing nasal swelling and congestion. They are available over the...
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

Retracted Ear Drum

  What Is a Retracted Eardrum? A retracted eardrum, also known as tympanic membrane retraction, is a condition where the eardrum (tympanic membrane) is pulled inward or drawn backwards from its normal position. The eardrum is a thin, delicate membrane that separates the outer ear from the middle ear. It plays a crucial role in transmitting sound vibrations from the outer ear to the middle ear, where the auditory ossicles (small bones) are located.   Under normal circumstances, the eardrum is slightly concave and positioned at an angle that allows it to respond to changes in air pressure. The Eustachian tube, a tube connecting the middle ear to the back of the throat, helps equalize pressure between the middle ear and the outside environment.   However, in cases of a retracted eardrum, the Eustachian tube might not function correctly or become blocked, leading to an imbalance in pressure. When negative pressure builds up in the middle ear, it causes the eardrum t...
Read more

LAX VOX

  LAX VOX  is a vocal therapy technique that can help improve voice quality, relaxation, and overall vocal health. It involves using a unique tube to create  bubbling sounds  while phonating.  Here are the steps for practising LAX VOX: Relax and Focus on Posture and Breathing : Maintain a good posture with a long spine. Relax your face, neck, upper back, and chest muscles, allowing them to release toward gravity. Preparing for Bubbling with Phonation : Place a  silicone tube  (about 35 cm long and 9-12 mm in diameter) between or in front of your incisor teeth and above your tongue. Keep your tongue relaxed (imagine it as a piece of steak) and slightly touch the tube. Hold the water-filled bottle near your body to avoid using shoulder muscles. Inhale through your nose as if you’re yawning with your mouth closed. Prepare for phonation during exhalation, focusing on abdominal and lower back muscles. Finding the Target Voice : Create bubbling sounds with y...
Read more

Quinsy Abscess

 How to tell the difference between tonsillitis and quinsy? 🤔🩺 Tonsillitis vs. Quinsy: Spotting the Differences 🩺🤔   Feeling under the weather with a sore throat? It's essential to know the difference between tonsillitis and quinsy. Here's how to tell them apart:   1. Tonsillitis:   Symptoms: Sore throat, difficulty swallowing, fever, swollen tonsils with white or yellow patches, swollen lymph nodes in the neck, and possibly a cough and hoarse voice. Cause: Usually viral or bacterial infections, such as the common cold or strep throat. Treatment: Rest, hydration, over-the-counter pain relievers, and sometimes antibiotics for bacterial tonsillitis. 2. Quinsy (Peritonsillar Abscess):   Symptoms: Severe sore throat on one side, difficulty swallowing, fever, drooling, muffled voice, swollen tonsil on one side, swollen uvula, and possibly a visible abscess on the tonsil. Cause: Complication of untreated or inadequately treated tonsillit...
Read more

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