Background:
Study presents the case of a 27-year-old man admitted to our clinic with unilateral stable hearing loss in the right ear which had been present for about 10 years. Patient’s medical history did not suggest inflammatory or trauma-related etiology of hearing loss.

Material and Methods:
Pure tone audiometry tests showed conductive hearing loss of 40 dB in right ear and normal hearing in left ear. Exploratory tympanotomy revealed atrophy of the distal 2/3 of the long process of the incus, with an extant thin strand of connective tissue joining the remnant of the long process of the incus with the stapes head. During reconstruction, the missing part of the incus was rebuilt using glass ionomer cement, with this strand serving as a core of the reconstructed part.

Results:
The missing part of the incus was successfully restored preserving the mobility of the ossicular chain. Pure tone audiometry performed at 1 and 12 months after surgery showed improved hearing in operated ear and closure of the air-bone gap.

Conclusions:
There are rare cases presenting with ossicular damage without history of otitis media or head trauma in which etiology is not possible to ascertain. Alloplastic reconstruction of atrophied elements using a glass ionomer cement is an effective treatment method producing lasting hearing improvement.