Homograft ossicles have been utilized in reconstructive middle ear surgery since 1964. In the first few years, simple repositioning of the incus was the method used. Due to the shortcomings of this procedure, a sculptured ossicle, the notched incus, was introduced in 1970 and this has gradually evolved into two standardized and reliable prostheses. In 1972 hearing results were published on the first 122 cases. An expanded study in 1977 reported in detail on 361 ears. The current study reports the results of 326 patients operated upon during the 5 year period of 1976 through 1980 and compares them with the previous studies. The overall hearing results are very similar for both series with little change being noted in the failure rate. However, in the successful categories progress seems to have been made in that a greater percentage of the fair to good results has been shifted to the excellent category. A new concept of ossicular reconstructions is demonstrated with the introduction of the notched incus with high and low profile, to compensate for differences in the stapedial mallear relationship.