Learning Objectives: To overcome the impedance mismatch between the tympanic membrane and cochlear fluids, the normal ossicular chain functions as a lever system.

Several surgical techniques are available to restore its continuity in case of interruption. Biocements are one of the latest innovations and allow maintaining the normal tri-ossicular structure, which results in a more physiologic energy transfer. Hydroxyapatite is an inorganic mineral and natural component of the human bone. It can be easily prepared by mixing a powder and liquid component, which subsequently forms a paste that slowly hardens. Compared to ionomeric cement, hydroxyapatite does not provoke any inflammatory reaction when in contact with the soft tissues of the middle ear. This workshop shows the application of hydroxyapatite cement in bridging incudostapedial discontinuity as well as other ossicular interruptions in a faster and easier way. Moreover hydroxyapatite cement can be used to stabilize ossicular prostheses. Based on retrospective case series the functional results with cement are initially similar to standard ossiculoplasty techniques but better over time.