Ossiculoplasty: some physical and physiological considerations.

Numerous techniques and many materials are available to the surgeon for the reconstruction of defects of the tympano-ossicular system. The author would like modestly to recall certain aspects of middle-ear physiology and physics, and the impact that a knowledge of these ought to have in the mind and in the action of a surgeon about to practise an ossiculoplasty. The ideal for an ossiculoplasty would be to respect the ossicular joints, to remember that sound transmission at the level of the footplate falls within the field of quantic mechanics. The stapes transmits sound energy to the inner ear virtually without movement. Let us pay the greatest respect to the malleus and make use of the tympano-mallear complex during ossicular reconstruction. Let us remember that the middle ear is an adaptor for acoustic impedance. Let us respect the resonance frequencies of the ear, by avoiding an increase in the mass with unnecessarily heavy devices, or an increase in the stiffness, and let us seek to have a well-ventilated middle ear and a reconstruction without excessive tension. Let us use materials that are as physiological as possible in the field of impedance and speed of sound transmission. Finally, let us try to reconstitute the most physiological ossicular chain possible, using three ossicles whenever we can, using the malleus and avoiding if possible direct drum footplate contacts.