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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



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