Introduction: The condition of the ossicular chain is closely linked to the extent of conductive hearing loss (CHL) when the tympanic membrane (TM) remains undamaged. This study aims to evaluate the correlation between intraoperative observations and audiological data in individuals presenting with unilateral CHL and an intact TM. Materials and Methods: The study included 78 patients who underwent surgical procedures. Patients were categorized according to intraoperative findings. The analysis included demographic information, intraoperative observations, and preoperative as well as postoperative audiological outcomes. Results: Patients with ossicular chain disruption demonstrated significantly more favorable outcomes compared to those with ossicular chain fixation. Preoperatively, patients with ossicular chain deformities exhibited higher air conduction threshold [ACT] and a widerair bone gap [ABG] compared to those with cholesteatoma, though postoperative outcomes were similar between the two groups. Conclusion: The surgical outcomes for congenital ossicular chain anomalies were comparable regardless of the underlying pathology. In contrast, patients with acquired conditions had better audiological outcomes following ossicular chain disruption than those with ossicular chain fixation. Ossicular chain reconstruction can lead to significant improvements in hearing for patients with unilateral CHL and an intact TM.