Surgical Approaches to the Ossicular Chain

The surgical approach for ossiculoplasty, also known as ossicular chain reconstruction, is chosen based on the extent of concomitant middle ear or mastoid disease, such as chronic otitis media or cholesteatoma. The primary objective of the surgical approach is to adequately expose the middle ear ossicles, diagnose the ossicular chain pathology, and facilitate reconstruction. Surgeons may employ microscopes and/or endoscopes for visualization and access the ossicular chain through a variety of surgical corridors including the transcanal, endaural, transmeatal, postauricular, and transmastoid/transfacial recess approaches. Endoscopic approaches allow enhanced visualization of the middle ear and demonstrate comparable hearing outcomes to microscopic approaches.