Biological Reconstruction of the Ossicular Chain

ONE OF THE MAIN aims in modern tympanoplasty is reconstruction of the ossicular chain. It is generally agreed that when the ossicular chain is interrupted functional results obtained by standard tympanoplastic methods, Wullstein's type 3 or, especially, type 4, are often not satisfactory. That is why many procedures and techniques attempting to reconstruct the ossicular chain have been invented and published.¹⁻⁶They may be divided into three groups, depending on what material is used for reconstruction of the chain: (1) ossicular tissue; (2) bone or cartilage as autografts; and (3) prosthetic devices, most often in the form of polyethylene tubes. A patient's own ossicles are often the most ideal reconstructive material for the ossicular chain.¹,³,⁶The use of prosthetic devices has become popular because of the relative simplicity of this procedure. But some drawbacks of introducing a foreign material into the middle ear, especially in cases with chronic