Today, the reconstruction of the ossicular chain is standard in middle ear surgery. It is performed as a one step procedure in cases of non-inflamed middle ears, as well as in cases of chronic ear diseases. In contrast to the past, a large tympanic cavity is today regularly reconstructed, which contributes to a normally ventilated middle ear. Reconstruction of the ossicular chain is necessary to keep the tympanic membrane in its normal position.However, many modern prostheses are available with different designs and material properties. This article aims to give an overview of the acusto-mechanical and surgical aspects of ossicular chain reconstruction. After a description of normal middle ear vibration, the biomechanical background of the reconstructed middle ear (incus reconstruction, stapes reconstruction) is discussed.