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No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To describe the use of total ossicular pros-theses (TOPs) in the setting of stapedectomy requiring an incus bypass procedure. (2) To analyze the short- and long-term audiometric results of TOP utilization in the setting of stapedectomy for an incus bypass procedure. Study Design. Case series with chart review. Setting. Tertiary neurotologic referral center. Subjects and Methods. Seventeen cases of TOP reconstruc-tion after stapedectomy were performed due to advanced incus erosion. The cases were assessed for pre- and post-operative bone conduction and air conduction pure-tone averages (PTAs; 0.5, 1, 2, 3 kHz), including high-tone bone conduction (1, 2, 4 kHz), air-bone gap, and speech discrimi-nation scores. Hearing outcomes were measured: short-term (3 weeks) and long-term (average, 22 months). Results. Among 17 ears undergoing revision stapedectomy man-aged with TOP reconstruction, the average number of previous revision attempts was 1.0 (SD, 1; range, 1-5). The preoperative bone conduction PTA was 30.7 dB preoperatively, while the preoperative air conduction PTA was 64.3 dB. The mean post-operative air-bone gap significantly decreased to 18.9 dB (SD, 12.7; range, 5-46.25; P \.003) with a mean follow-up of 22.2 months (SD, 25.0; range, 0.75-78). No significant decrement in high-tone bone conduction PTA was observed (mean, 0 dB; SD, 12.8; range, –36.7 to 20; P =.427); however, 1 ear revealed a severe decrease in PTA and speech discrimination score post-operatively. No further revisions were noted in follow-up. Conclusion. TOP reconstruction in the setting of previous revision stapedectomy with limited incudovestibular recon-structive options may lead to favorable hearing outcomes, but it carries an increased risk of sensorineural hearing loss