This patient had a cholesteatoma that had eroded the incus. Moreover, it was difficult to mobilize the malleus which was fixed with tympanosclerotic deposits in the attic. An incus replacement prosthesis would not have worked in this situation.
It was therefore decided to bypass the malleus and place a partial ossicular replacement prosthesis (PORP) between the drum and the capitulum of the stapes.
The cholesteatoma has been removed. The incus is absent. The chorda tympani is seen coursing medial to the malleus and above the head of the stapes. Note the erosion of the tip of the manubrium and the tympanosclerosis fixing the head of the malleus in the attic.
This picture shows the PORP placed over the head of the stapes.