Reconstruction of the ossicular chain in an ear damaged by chronic otitis and radical mastoid surgery remains a challenging problem in otology today. The various principles used for ossiculoplasty for such cases in our clinic are highlighted. A modified classification of ossicular chain defects is proposed, which characterizes the level and extent of the defect within the ossicular chain. Autologous materials such as fingernail, cartilage and cortical bone are preferred in patients with chronic otitis media. Prostheses are placed taking into account the optimal positions for sound conduction. In patients having undergone radical mastoid surgery, ossiculoplasty is performed as the final stage after the reconstruction of vital middle ear structures i.e. the posterior canal wall and tympanic membrane.
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