Ossiculoplasty in London
Specialist assessment and reconstruction of the middle-ear hearing bones with Mr Max Whittaker, Consultant ENT Surgeon specialising in otology and ear surgery.
Ossiculoplasty is used in selected patients when damage, erosion or disruption of the ossicular chain contributes to conductive hearing loss.
Reconstruction of the ossicular chain where damage contributes to conductive hearing loss.
What are the ossicles?
The ossicles are the three small hearing bones of the middle ear that help transmit sound from the eardrum towards the inner ear.
The bones are called the malleus, incus and stapes. Together they form a mechanical chain between the tympanic membrane and the inner ear.
Chronic ear disease, cholesteatoma, previous surgery, infection or trauma can sometimes damage or interrupt this chain.
When the ossicles cannot transmit sound effectively, conductive hearing loss may result. Ossiculoplasty may be considered when reconstruction is clinically appropriate.
When might ossiculoplasty be considered?
The decision depends on the underlying ear disease, hearing tests, condition of the eardrum and the remaining middle-ear structures.
Ossicular erosion
Chronic ear disease can damage one or more of the hearing bones.
Conductive hearing loss
Testing may show reduced sound transmission through the middle ear.
Cholesteatoma
Cholesteatoma can erode the ossicles and may require disease-control surgery with later or simultaneous reconstruction.
Previous ear surgery
Reconstruction may be considered where previous disease or surgery has left the ossicular chain disrupted.
Tympanoplasty
Ossicular reconstruction may form part of wider tympanoplasty when both the eardrum and middle-ear structures require treatment.
Selected traumatic injury
Trauma can occasionally disrupt the ossicular chain and lead to conductive hearing loss.
Hearing loss needs to be understood first
Ossiculoplasty is only relevant where the middle-ear hearing mechanism is contributing to the hearing problem.
Clinical history
Previous infections, discharge, perforation, trauma, cholesteatoma and earlier surgery are reviewed.
Ear examination
The eardrum and visible middle-ear structures are assessed for disease and structural changes.
Hearing tests
Audiology can help distinguish conductive hearing loss from inner-ear hearing loss.
Surgical planning
Reconstruction is considered alongside the condition of the eardrum and any active or previous middle-ear disease.
What happens during ossiculoplasty?
The aim is to improve the mechanical connection between the eardrum and inner ear where this can be done safely and appropriately.
Inspect the ossicular chain
The surgeon assesses which parts of the ossicular chain remain intact and mobile.
Remove or treat disease where required
If chronic disease or cholesteatoma is present, safe control of the disease takes priority.
Reconstruct the sound-conduction pathway
Reconstruction may use the patient’s existing ossicular material, other suitable tissue or a prosthetic reconstruction depending on the clinical situation.
Reconstruct the eardrum where needed
Ossiculoplasty may be performed together with tympanoplasty where the tympanic membrane also requires reconstruction.
Can ossiculoplasty restore hearing?
Ossiculoplasty aims to improve sound transmission through the middle ear, but the degree of hearing improvement varies between patients.
Normal hearing cannot be promised because hearing depends on several parts of the ear working together.
Outcome can be influenced by the condition of the eardrum, remaining ossicles, middle-ear environment, previous disease and inner-ear hearing function.
In some patients, the primary objective of surgery is disease control or creation of a safe ear rather than hearing restoration.
Learn about Mastoid Surgery →Ossiculoplasty may form part of wider ear surgery
Middle-ear reconstruction is often considered in the context of the underlying condition rather than as an isolated procedure.
Eardrum and middle-ear reconstruction
Ossiculoplasty may be combined with tympanoplasty when the eardrum and ossicular chain both require reconstruction.
Myringoplasty & Tympanoplasty →Disease control first
Where cholesteatoma is present, removing and controlling disease is the priority. Hearing reconstruction may be performed at the same operation or considered separately.
Mastoid Surgery →Surgical visualisation
Endoscopic techniques may be used during selected middle-ear procedures, either alone or alongside microscopic surgery.
Endoscopic Ear Surgery →Recovery after ossiculoplasty
Recovery depends on whether ossiculoplasty was performed alone or alongside tympanoplasty, cholesteatoma surgery or another procedure.
Patient InformationHearing may initially feel reduced
Packing, swelling and the healing process can temporarily affect hearing after surgery.
Keep the ear dry
Water precautions may be required while the eardrum and middle ear heal.
Attend follow-up
Postoperative review allows the surgeon to assess healing and remove packing where required.
Hearing is assessed after healing
Audiology may be repeated once the ear has had sufficient time to heal.
Activity advice is individual
Work, exercise, swimming and other activities should resume according to the instructions given by your surgical team.
Ask before flying
There is no single flying interval that should be applied to every patient after middle-ear surgery. Follow your surgeon’s advice.
Specialist expertise in otology and middle-ear surgery
Mr Max Whittaker specialises in otology, chronic ear disease, hearing loss and reconstructive ear surgery.
His advanced surgical training includes Otology and Skull Base Surgery at Guy’s and St Thomas’, together with international observership experience at the House Institute in California and Toronto General Hospital.
Mr Whittaker also holds an MSc with Distinction in Audiovestibular Medicine from UCL and is Clinical Lead in Otolaryngology at Homerton Healthcare NHS Foundation Trust.
From hearing assessment to treatment planning
Book your consultation
Submit a secure appointment request and indicate your preferred London clinic.
Request consultation →Examine the ear
The eardrum and middle ear are assessed together with your history and previous treatment.
Review audiology
Hearing tests help establish whether the ossicular chain is likely to be contributing to conductive hearing loss.
Discuss reconstruction
The potential role, limitations, risks and alternatives to ossiculoplasty can then be discussed individually.
Common questions about middle-ear reconstruction
An individual assessment is required to determine whether ossiculoplasty is appropriate.
Ossiculoplasty is reconstruction of the ossicular chain, the small bones that transmit sound through the middle ear.
Damage can occur because of chronic ear disease, cholesteatoma, trauma, previous infection or previous ear surgery.
Normal hearing cannot be guaranteed. Outcome depends on the condition of the middle ear, eardrum, remaining hearing bones and inner-ear function.
Yes, in selected patients ossicular reconstruction may form part of a wider tympanoplasty when the eardrum and middle-ear structures both require treatment.
Flying advice depends on the operation and healing of the individual ear. Your surgical team should confirm when it is safe for you to fly.
Use the secure Book Consultation page to submit an appointment request. The clinic team will then contact you to confirm availability and appointment details.
Discuss whether ossiculoplasty may be appropriate
Request a private consultation with Mr Max Whittaker for specialist assessment of your hearing and middle-ear condition.