The Borrowed Ossicle in Tympanoplasty

THE INNOVATION of repositioning the incus fragment in order to reconstruct the ossicular chain during tympanoplasty has been one of the most significant advances in otologic surgery. This concept was proposed by Hall and Rytzner1in Sweden. Recent articles by Guilford2and Sheehy3have reported encouraging hearing results from the use of this technique. Following an excellent resume on ossicular problems, Sheehy concludes "repositioning of ossicular tissue has proved to be the most reliable ossicular reconstruction technique in our hands." But what if no incus, malleus, or even stapes superstructure remains? These are the very cases where the use of metal or plastic prostheses has been the most discouraging. In these cases a homograft incus obtained from a fresh cadaver temporal bone (the borrowed ossicle) has been utilized in the same fashion as the patient's own ossicle. This substitution is easily made because the ossicles are almost