<p>To evaluate the prognosis in CSOM patients undergoing ossiculoplasty using OOPS index in our tertiary care centre. The present study was conducted in our institute on 90 COM patients with or without cholesteatoma. All relevant clinical data (demographics, comorbid conditions, clinical features, surgical outcomes and intraoperative findings) was collected from all subjects. All patients underwent surgical intervention depending on the extent of the disease and OOPS index was calculated. The study included 90 patients aged 15-60 years (mean 32.4b +/- 7.11 years), with most patients in the 31-40 year age group and a slight female predominance and ratio being 1.09:1. Chronic otitis media without cholesteatoma was seen in 68.9% of patients, while 31.1% had cholesteatoma. The long process of the incus was the most commonly affected ossicle (71.1%). Ossiculoplasty was most commonly performed using autologous incus (56.7%), followed by PORP (41.2%) and TORP (2.2%). Most patients belonged to low risk OOPS group (61.1%). Audiological gain was significantly higher in low- and intermediate- risk groups compared to the high-risk groups and better hearing outcomes were observed in patients without cholesteatoma compared to those with cholesteatoma. The findings of this study emphasizes the importance of careful case selection in ossiculoplasty with significant better outcomes observed in patients with lower OOPS scores, supporting the use of preoperative prognostic scoring. Additionally, the results reaffirm the effectiveness and cost-efficiency of autologous graft materials, particularly cartilage and bone, making them reliable first-line options, especially in resource-limited settings.</p>