Objective: To compare the complication rate and hearing results of a new, lightweight, titanium ossicular replacement prosthesis with Plastipore prostheses (Xomed, Jacksonville, FL). Study Design: Retrospective. Methods: Charts were reviewed for type of operation, type of prosthesis used, extrusion rate, prostheses failure rate, and hearing thresholds at multiple frequencies and at multiple follow-up points. The dependant variable for hearing results was the four-frequency average air-bone gap. Results: There were 84 patients undergoing tympanoplasty with the Plastipore prosthesis and 53 with the titanium. There was one extrusion in the titanium group. There was an additional single incidence of prosthesis failure in the titanium group. Overall hearing results were comparable with an air-bone gap average of 19.3 dB in the Plastipore group compared with the titanium group with an air-bone gap of 22.0 dB (P = .08). Sixty percent of patients had a postoperative air-bone gap of 20 dB or less in the Plastipore group. In the titanium group, 45.3% achieved a 20 dB or less postoperative air-bone gap. Plastipore had a lower air-bone gap than the titanium when a canal wall up operation was performed (17.8 vs. 23.9 dB) and tended toward a lower air-bone gap when a total ossicular prosthesis was needed (22 vs. 27 dB) (P < .07). Conclusion: The titanium prosthesis is a new ossicular replacement prosthesis that provides excellent visualization during insertion and provides hearing results that are comparable with Plastipore. The Plastipore prosthesis performed better in canal wall up mastoidectomy situations and tended toward better performance when a total ossicular replacement prosthesis was needed.