With the exception of stapes prostheses, previous use of implantable alloplastic materials in reconstructing the sound conducting mechanism in middle ear surgery has been uniformly unsuccessful. A new material composed of ultra-high molecular weight polyethylene has been developed as a replacement for middle ear ossicles. This implant, called the Plastipore total ossicular replacement prosthesis (TORP), and the Plastipore drum to the stapes prosthesis were inserted in 87 patients, all of whom had a long history of extensive middle ear disease and/or surgery. One TORP patient was lost to follow-up. The overall average hearing gain was 14.8 db. The overall follow-up was 12.4 months with a range of from 3 to 25 months. Eleven of the 15 patients receiving the drum-to-stapes prosthesis had hearing gain; 55 of 71 patients receiving the TORP had hearing gain. Eight prostheses were extruded. Nine patients had no improvement in hearing. Eight patients had subsequent decrease in hearing after initial gains. All ears are now dry and aerated. Early evaluation appears to demonstrate that the Plastipore prosthesis shows promise for use in difficult reconstructive middle ear problems.