What Effect Does Smoking Have on the Surgical Closure of Tympanic Membrane Perforations? A Review.

Abstract

The link between cigarette smoking and outcome following surgical repair of tympanic membrane perforation is unclear. The objective of this study was to conduct a systematic review on the link between smoking and success rate following surgical repair of tympanic membrane perforations. Systematic review performed using the following data sources: 1) Cochrane central register of controlled trials (1997 to April 30, 2018), 2) Medline (February 1948 to April 30, 2018), and 3) Embase (1975 to April 30, 2018). Inclusion criteria for this study was: 1) studies reporting surgical closure of tympanic membrane perforations in smokers, 2)primary and revision cases, 3) English language literature, 4) minimum follow-up period of 6 months, and 5) pre and postoperative audiogram. The exclusion criteria were: 1) no identifiable data on smokers in reported outcomes, 2) less than 6 months follow-up, 3) no audiometric outcomes, and 4) non-English language articles. A total of 75 studies were identified on initial search and 8 were eligible for the study. All studies were of level 4 evidence. In these eight studies, overall surgical closure of tympanic membrane perforation was successful in 512/577 (88.7%) of nonsmokers and 151/197 (76.6%) in smokers. This difference was statistically significant. Smokers may have a lower success rate compared against nonsmokers for surgical repair of tympanic membrane perforations. Our review has limitations and more prospective high-quality controlled trials are required to further study this association.