ObjectiveTo determine factors that predict hearing results using a standard prosthesis system.Study DesignRetrospective chart review.SettingTertiary referral center.PatientsAll patients undergoing ossiculoplasty with the Dornhoffer HAPEX partial and total ossicular replacement prostheses (PORP and TORP) from February 1995 to May 1999 who had documented postoperative follow-up and no congenital atresia or stapes fixation. A total of 185 patients (200 ears), 105 men and 80 women, were evaluated.InterventionsOssiculoplasty with the Dornhoffer prostheses.Main Outcome MeasuresHearing results using a four-frequency pure-tone average air–bone gap (PTA-ABG). Multivariate statistical analysis determined the effect of mucosal status, ossicular chain status, and type of reconstruction techniques on hearing.ResultsThe PTA-ABGs were 13.4 ± 8.1 dB and 14.0 ± 8.4 dB for the PORPs (n = 114) and TORPs (n = 86), respectively, which was not statistically different. When the malleus handle was present (n = 126), the PTA-ABG was 11.6 ± 6.2 dB, compared with 16.9 ± 10.1 dB when it was absent (n = 74), which was statistically significant (p < 0.05). Mucosal fibrosis, drainage, revision ear surgery, and type of surgical procedure had a significant detrimental impact on hearing. The type of pathologic process (perforation vs. cholesteatoma) had no significant impact on hearing results.ConclusionsThe revised staging system, the Ossiculoplasty Outcome Parameter Staging Index, more adequately predicts hearing outcome in this series of 200 cases.