The ossicles, which can be distinguished as the malleus, incus, and stapes, are three bones in the middle ear that help mechanically transmit sound energy. Sound energy is collected by the tympanic membrane and then transmitted to the middle ear along with the three middle ear bones and the fluid-filled cochlea. Collectively, the bones of the middle ear form the auditory chain. However, damage to the structural elements of the middle ear can cause hearing loss, which is defined as conductive hearing loss. Chronic otitis media causes in the majority of cases perforation of the tympanic membrane, which is corrected by placing a graft at the site of the rupture. However, in some cases, along with the repair of the perforation, the restoration of the continuity of the auditory chain with ossiculoplasty is also indicated.

Chronic otitis media & consequences

Chronic otitis media and its sequelae, such as cholesteatoma and atelectasis, account for the majority of cases of disruption of the auditory chain. The remaining cases are due to blunt and penetrating trauma, tympanic sclerosis, congenital malformations, congenital absence of bone, and middle ear neoplasms. Damage to the auditory ossicles that make up the auditory chain in many cases cause the interruption of this smooth continuity, leading to the manifestation of conductive hearing loss.

These three bones are responsible for converting sound into vibrations, which are then transferred to the inner ear. The goal of ossiculoplasty is to restore the continuity of the auditory chain and improve the mechanism of conduction of sound to the inner ear in patients suffering from conductive hearing loss due to some form of chronic otitis media.

What does ossiculoplasty involve?

Ossiculoplasty is the surgery of choice to correct any problems with the tiny bones that are responsible for transmitting sound from the eardrum to the inner ear. The operation is often performed at the same time as tympanoplasty, but may also be performed alone. There are two main categories of ossiculoplasty, segmental and total reconstruction. In ossiculoplasty, the majority of the non-functional bones is removed, and then special prosthetic bones made of plastic or metal are placed with the aim of restoring the acoustic continuity.

Ossiculoplasty: Surgical process

The approach to the middle ear is the same as tympanoplasty, either through the ear canal through a small upper incision (transcanal approach) or by gaining access behind the ear (postauricular approach). The surgeon then lifts the intact eardrum to enter the middle ear. Once the middle ear cavity is approached and exposed, the ossicles are inspected for defects and gently palpated in order for the doctor to assess their mobility and continuity. Then, their reformation is carried out by placing special prefixes. After osteoplasty, the patient stays for 1 to 2 nights in the hospital, while it is recommended to refrain from daily activities for a period of two weeks. ENT surgeon in Athens Dr. Olga Papadopoulou restores the continuity of the auditory chain with care, effectively treating conductive hearing loss.