The Association of Valsalva Status With Smoking and Its Impact on Ossiculoplasty Outcomes and Complications.

Abstract

To assess the association of a patient's ability to perform a clinically observed Valsalva maneuver with tobacco smoking and post-ossiculoplasty outcomes. Case series with chart review. Tertiary referral, university-based otology practice. Adult patients (16-88 years of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts, retrograde mastoidectomy with canal wall reconstruction, or mastoid obliteration techniques. Patients were classified as Valsalva negative (Val) or positive (Val). Comparisons were then made between these two groups for smoking status, final audiometric outcomes, rate of cure of conductive hearing loss, anatomic outcomes, and incidence of significant complications after otologic surgery involving ossiculoplasty. Tobacco smoking is not significantly correlated with the inability to insufflate the middle ear with the Valsalva maneuver (p = 0.557). An insignificant difference in final pure-tone average air-bone gap (PTA-ABG) was observed between the Val and Val groups (20.2 dB HL versus 18.2 dB HL, respectively; p = 0.152). Similarly, the rate of successful PTA-ABG closure to ≤20 dB HL was not significantly different between the groups (62.5% [80 of 128] of Val patients and 56.8% [54 of 95] of Val patients [p = 0.394]). Postoperative complications were seen with a higher frequency in the Val patients (16.8% [16 of 95] versus 7.0% [9 of 128]; p = 0.022). A patient's inability to perform the Valsalva maneuver is not significantly associated with smoking; however, negative Valsalva status is associated with an increased incidence of significant complications after ossiculoplasty.