Page JC, et al. - Researchers compared the long-term hearing outcomes following ossiculoplasty with cartilage tympanoplasty with (M+) and without (M−) the malleus present. In the M+ group, there were 46 patients and there were 80 in the M− group. Findings suggested statistical significance of the malleus with regard to its impact on final audiometric outcome following ossiculoplasty. Results demonstrated its implications in the clinic, particularly in the use of the Ossiculoplasty Outcome Parameter Staging (OOPS) index as a prognostic tool, and will likely lead to its revision. They noted the probability of these data to support the coupling theory of acoustic gain and weaken the catenary lever theory.