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Ossicular chain reconstruction


  • Ossicular chain reconstruction is a surgical procedure in the middle ear to treat hearing loss caused by disruption or damage of the ossicular chain-- a system of 3 tiny bones (malleus, incus and stapes) responsible for the transfer of sound vibrations from the eardrum to the inner ear. 
  • Ossicular chain reconstruction results in a type of hearing loss called conductive hearing loss. This can be congenital or result from trauma or middle ear disease and infection. 


  • Hearing loss due to damage to the ossicles is the main indication for the procedure of ‘ossiculoplasty’. There is usually damage to the joint between the incus and the stapes which needs to be corrected. There may be damage to the malleus bone due to infection. 
  • There may be sclerosis in any of the bone, thereby causing deafness. Any person who has conductive hearing loss may undergo ossiculoplasty. There is no major contraindication for this surgery. 


  • The healing time for ossicular chain reconstruction is usually between 4 to 6 weeks, but patients are usually able to return to their jobs after one week. 


  • After spending several hours in the recovery area, you will be discharged home. Pain associated with the procedure is typically mild, and is resolved by taking the prescribed pain medications. 
  • Do not be concerned regarding your hearing during the healing process. It takes 6 – 8 weeks before we can evaluate improvement and your hearing will be tested at that time.
  • Bloody or watery drainage from the incision area may occur during the first 7 – 10 days. If this happens, tape a piece of gauze over the area. 


  • Where is the ossicular chain located? 

The ossicles are situated in the middle ear and suspended by ligaments. They articulate with each other through synovial joints to form a chain across the length of the middle ear from the tympanic membrane (laterally) to the oval window (medially). 

  • How successful is ossicular chain reconstruction? 

Results: Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63dB and decreased to 17.26dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. 

  • Can the ossicles be surgically replaced? 

Ossicular chain reconstruction can improve conductive hearing. It is also called middle ear bone surgery. It can be done to replace a damaged malleus or incus bone. During surgery, you will be given local anesthesia with sedation. 

  • Is ossicular chain reconstruction painful? 

Pain is relatively mild (Pain Score: 3/10 for the first 3 days), but this will resolve gradually over the next 5 days. The ear bandage may be removed 2 days after surgery. Any sutures used are absorbable and do not need removal. Hearing gradually improves over several weeks. 

  • What is ossicular chain discontinuity? 

Ossicular chain dislocation is a separation of the middle ear bones. It results in a hearing loss due to sound not being transmitted properly (conductive hearing loss). Ossicular chain dislocation is also called ossicular chain discontinuity.

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