We have examined the suitability of ceramic materials for reconstruction in middle ear surgery. The excellent tolerance of bio-inert aluminum oxide ceramic implanted into the middle ear has been shown by our electron microscopic studies and clinical experience. Our implants developed for ossicular chain reconstruction were covered by a delicate middle ear mucous membrane within a few weeks. We have observed no foreign body reactions. The ceramic prostheses are distinguished by the almost unlimited number of forms or shapes into which they can be ground quickly and precisely during the operation. We value Al2O3 ceramic implants because there is no bony fixation with the surrounding bone, but rather a jointlike connection with the remaining parts of the ossicular chain. The composition of resorbable tricalcium phosphate, bio-active ceramic, corresponds to the inorganic component of bone. Because it exhibits the characteristic of being replaced by autogenous bone, we consider it for the obliteration of mastoid cavities. Based on our preliminary experience, dense tricalcium phosphate ceramic might play a valuable role in the reconstruction of the posterior auditory canal wall. In addition, we have used dense tricalcium phosphate ceramic to correct minor ossicular chain defects (for example, erosion of the long process of the incus). A survey is given concerning the indications and techniques for the use of these new materials in middle ear surgery, as well as our results covering a period of three years, which are very encouraging as far compatibility and function are concerned.