Ossiculoplasty

Ossiculoplasty is surgery to reconstruct the three tiny bones in your middle ear (ossicles). Sound waves travel from your eardrum across these bones—the malleus, incus, and stapes—to reach your inner ear, a pathway called the ossicular chain.

Damaged or abnormal ossicles, called ossicular chain discontinuity, prevent sound from reaching your inner ear. When this happens, your ear can’t transmit electrical signals to your brain. Ossiculoplasty, or ossicular chain reconstruction, rebuilds the ossicular chain so you can hear better. The procedure usually involves prostheses, artificial implants that replace damaged or missing ossicles.

Ossicular chain discontinuity is a common cause of conductive hearing loss, when sound can’t reach your outer or middle ear. Problems with your eardrum (tympanic membrane) can also cause conductive hearing loss. Some people need tympanoplasty (eardrum reconstruction) ;at the same time as ossiculoplasty.

At Penn Medicine, our ear, nose, and throat specialists have fellowship training in otology and neurotology. This advanced level of expertise means they specialize in diagnosing and treating complex forms of hearing loss and ear diseases. Middle ear reconstruction, such as ossiculoplasty, requires a high level of technical skill. Our surgeons routinely operate on the delicate structures in the middle ear with excellent results.

We may recommend ossiculoplasty surgery if you have problems with your middle ear bones related to: 

• Cholesteatoma: mass of skin cells in your middle ear behind your eardrum 
• Chronic middle ear infections: inflammation that erodes the ossicles (most common cause of ossicular chain discontinuity) 
• Congenital ossicle defects: ear bones that are missing or abnormal from birth 
• Ear cyst or tumor: benign or cancerous growths that spread to the middle ear 
• Ear trauma: blunt or penetrating injuries to the middle ear  
• Otosclerosis: abnormal bone growth in your middle ear 

Before ossiculoplasty, we review your medical history and conduct a physical exam. Your health-care provider may use an otomicroscope (special microscope with a magnifying lens and camera) to examine your eardrum and middle ear. Hearing evaluations, such as tympanometry and impedance audiometry, help us assess the extent of hearing loss. We also do CT scans of your middle ear to examine and measure the ossicles and plan what prostheses to use.  

Your care team will provide detailed instructions about how to prepare for ossiculoplasty. Give your provider a complete list of any medications or supplements you take regularly, as well as any known allergies. Since ossiculoplasty requires general anesthesia, you shouldn’t eat or drink anything after midnight on the day of your surgery. Ossiculoplasty is an outpatient procedure, so you go home the same day.  

Here’s what to expect during middle ear surgery:  

1. You receive general anesthesia through an intravenous (IV) line in your arm.  
2. We attach small sensors to different parts of your face to monitor nerves and prevent damage.  
3. Your surgeon accesses your middle ear through your ear canal or by making an incision (cut) behind your ear.  
4. They also create a tympanomeatal flap (T-flap), which means lifting the skin of your eardrum to access the ossicle bones.  
5. Your surgeon uses small instruments to remodel or remove bones, implant the prostheses, and reconstruct the ossicular chain.  
6. If you also need tympanoplasty, your surgeon uses skin or cartilage from your head to repair your eardrum.  
7. Your ear is packed with an antibiotic-soaked sponge to prevent infection and stabilize the prostheses.  
8. Your surgeon replaces your eardrum over your middle ear and closes any incisions with stitches or staples.  

Recovery from ossiculoplasty can take up to six weeks. You should keep your ear dry and leave the packing in place. Your care team will give you instructions about showering. Avoid exercising, lifting weights, swimming, and flying until your provider says it’s safe. Don’t cough or blow your nose; keep your mouth open if you have to sneeze. Most people can return to work in a week.

Over-the-counter pain medication can help you manage any discomfort. Other temporary side effects may include dizziness, ear ringing or popping, ear numbness, or changes in your sense of taste. Some blood and discharge from your ear are normal, but contact your provider if you notice heavy bleeding or foul-smelling discharge.  

You’ll have a follow-up visit with your surgeon about a week after the procedure. You may start a course of antibiotic ear drops. If you have non-absorbable packing in your ear, we remove it after several weeks. We do a series of audiometry tests about three weeks after middle ear reconstruction to evaluate your hearing. It can take several months for your hearing to improve.  

All surgeries carry risks. Potential complications of ossicular chain reconstruction include:  

• Bleeding 
• Facial nerve injury 
• Hearing loss 
• Infection 
• Prosthesis displacement 

Penn Medicine offers the latest surgeries for middle ear reconstruction, including endoscopic procedures for ossiculoplasty and tympanoplasty. Whenever possible, we choose the least invasive approach to ease your recovery.  

Our multispecialty team gives you access to all the experts you need in one place. Otologists and neurotologists collaborate with audiologists and speech-language pathologists to help you rehabilitate and improve your hearing and speech skills after surgery.