When the malleus and the stapes supra structure are present, partial ossicular replacement prosthesis (PORP) can be used . When only malleus and mobile stapes footplate are present, total ossicular replacement prosthesis (TORP) can be used.

Although several options are available as regards the type of ORP, we prefer using a CAUSSE ORP which has head and shaft made of dense hydroxyapetite (HAPEX) and connecting tube made of Teflon which can be trimmed as per the length of the columella. The grooved head fits on the under surface of the head of malleus. In our experience this ORP gives very good closure of air bone gap and so far there has been no reported extrusion of the prosthesis.