The authors performed a retrospective analysis of 21 patients who had undergone primary reconstruction of the ossicular chain during canal-wall-down mastoidectomy. The ossiculoplasty technique used consisted of removal of the malleus head and division of tensor tympani, and rotation of the malleus remnant to lie on the stapes superstructure. The procedure was deemed to have failed in three of 21 cases due to presumed non-adherence of the stapes to the malleus neck. Subgroup analysis of the 18 successful procedures showed a mean post-operative air-bone gap of 15dBHL, 19dBHL, 8dBHL and 26dBHL at 0.5, 1, 2 and 4 kHz respectively. The patients’ pre- and post-operative sensorineural thresholds were not reported, so the practical benefit of the good conductive results cannot be ascertained; however no patients suffered a ‘dead ear’. The conductive gap outcomes compared favourably with modified radical mastoidectomy alone, although no direct comparisons were drawn by the authors with other patients undergoing other forms of reconstruction. They note that further work to compare the quality-of-life outcomes of such a reconstruction with other techniques would be useful. Patients had no recurrence of cholesteatoma during the follow-up period. The paper presents a suitable technique for single-stage ossicular chain reconstruction in canal-wall-down surgery, albeit in selected cases, as the procedure relies upon the presence of an intact stapes.