Objective <p>Type III-r ossiculoplasty (or incus reposition) is commonly used for transmastoid decompression of the facial nerve. Although this technique should also be applicable to cholesteatoma surgery with an intact ossicular chain, it has rarely been reported. The purpose of this study was to compare the postoperative outcomes of type III-r with other ossiculoplasty techniques in middle ear cholesteatoma surgery and to evaluate the efficacy of type III-r.</p> Methods <p>A retrospective chart review was performed on 227 ears (227 patients) with middle ear cholesteatoma that underwent initial surgery during the period between April 2013 and August 2023, with special reference to the 65 ears (65 patients: 41 males, 24 females, mean age 42.2&#xa0;years) in which the ossicular chain was found to be continuous during surgery. Preoperative and postoperative air conduction threshold (AC) and air-bone gap (ABG) were compared between the ossiculoplasty types. Postopereative recurrence rate of cholesteatoma were compared between the ossiculoplasty types, as well.</p> Results <p>The types of ossiculoplasty performed included type III-r (8 ears), type I (36 ears), type III-i (6 ears), and type III-c (15 ears). The percentage of patients with successful hearing results (ABG &lt; 20&#xa0;dB) was 100% for type III-r and type I, 100% for type III-i, and 85% for type III-c. Type III-r showed significant improvement in AC and ABG. During the follow-up period, there were no cholesteatoma recurrences in the type III-r, but 2 case recurrences (one residual and one reformation) after type I.</p> Conclusion <p>In surgery for middle ear cholesteatoma with intact ossicular chain, the type III-r ossiculoplasty showed comparable hearing result with the type I. Therefore, it may be legitimate not to exclude the possibility of adopting type III-r in surgery for cholesteatoma. However, this study is preliminary and further study is necessary to reassure the lower residual recurrence of cholesteatoma after type III-r than type I.</p>