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Objective:To evaluate the success of hearing results in total middle ear reconstruction with cartilage ossiculoplasty for the patients with old open- mastoidectomy cavities. Method: A retrospective review of 69 patients who underwent total middle ear reconstruction with cartilage ossiculoplasty was performed. Results: In this series, the successful hearing results were obtained in 61 % of the patients after operation, but 93% of the ears were dry. For patients with stapes, the successful rate was 65%; for patients without stapes,it was 58 %. The mean hearing gain was 10.7dB. Conclusion: Total middle ear reconstruction offers an effective treatment algorithia of hearing reconstruction for patients with old mastoidectomy cavities. 1. Stapes is important for hearing improvement; 2. Staged operation is good for hearing restoration; 3. For a large number of patients with a problematic cavitites, hearing restoration is possible by total middle ear reconstruction.