Sculpted autologous ossicle and cortical bone grafts were the first materials successfully used to reconstruct the ossicular chain in chronic ear surgery. Over the last 20 years, the use of biocompatible implants has been popularized; as a result, bone grafts have fallen into disfavor with most otologists. To determine if autologous bone grafts remain stable with time, 115 cases in which autologous bone grafts were used between 1971 and 1984 were reviewed. Eighty patients underwent Type III tympanoplasty, stapes arch present. Thirty-five underwent Type IV tympanoplasty, stapes arch absent. Minimum follow-up was 2 years; 30 patients were followed for > or = 10 years. In Type III tympanoplasty, overall the initial air/bone gap was 19.7 dB at 6 months, with 59% of those with improved hearing at 15 dB air/bone gap or better. Hearing remained stable for 10 years with overall hearing of 19.2 dB air/bone gap and 50% with an air/bone gap of < or = 15 dB. In Type IV tympanoplasty, the average air/bone gap was 26 dB at 6 months, with 70% of those having improved hearing with < or = 20 dB air/bone gap. At 10 years, the overall air/bone gap was 29.3 dB, with only 28% maintaining an air/bone gap of < or = 20 dB. Poor eustachian tube function and collapse of the middle ear air space were found to be the primary causes for long-term failure. The initial hearing results using autologous bone are comparable with those achieved with synthetic prosthesis. Hearing results using autologous bone remained stable through 5 years. Beyond 5 years, Type III tympanoplasty remained stable, while there was deterioration in Type IV tympanoplasty due to poor eustachian tube function.