Prognostic factors in type I tympanoplasty.

Abstract

To identify the preoperative factors that influence the success rate of type I tympanoplasty. A total of 247 type I tympanoplasty procedures were included in the present study. We determined the effects of the following preoperative variables on the anatomical and functional outcomes of type I tympanoplasty in order to identify prognostic preoperative factors: age (<16 years vs. >16 years), history of ear surgery, state of the contralateral ear (healthy vs. diseased), size of perforation, presence of septal pathology, presence of adenoid disease and history of smoking. Additionally, we stratified the surgical procedures according to the type of graft materials used and analyzed the effects of the above preoperative variables on the success rates of each type of procedure separately in order to eliminate the confounding effect of surgical technique. The study was conducted on 217 subjects (130 females, 87 males) who underwent a total of 247 surgical procedures. The graft take rate was significantly higher after tympanoplasty with perichondrium-cartilage island flap (PCIF) grafts than after tympanoplasty with temporalis fascia (TF) grafts (87.8% vs. 72.3%, p=0.008). Young age (p=0.013), presence of adenoid hypertrophy (p=0.001) and abnormality of the contralateral ear (p=0.027) were associated with lower success rates after tympanoplasty with TF grafts. The success rate of tympanoplasty with PCIF grafts was not affected by any of the preoperative variables we tested. Postoperative audiometry showed that the improvement in hearing ability did not differ between patients who received TF grafts and those who received PCIF grafts (p=0.325). Tympanoplasty with cartilage grafts was associated with better graft takes and comparable hearing outcomes than those associated with tympanoplasty with TF grafts. In patients with risk factors such as contralateral ear disease, a young age or adenoid disease, cartilage-perichondrium grafts are preferable to TF grafts.