Type I Tympanoplasty: surgical success and prognostic factors

Pedro Salvador; Patrícia Gomes; Francisco Silva; Rui Fonseca

doi:10.1016/j.otorri.2020.04.009

Type I Tympanoplasty: surgical success and prognostic factors

Acta Otorrinolaringol Esp (Engl Ed). 2021 May-Jun;72(3):182-189. doi: 10.1016/j.otorri.2020.04.009. Epub 2020 Aug 27.

[Article in English, Spanish]

Authors

Pedro Salvador¹, Patrícia Gomes², Francisco Silva², Rui Fonseca²

Affiliations

¹ Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal. Electronic address: josepedrobsalvador@gmail.com.
² Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.

PMID: 32862972
DOI: 10.1016/j.otorri.2020.04.009

Abstract

Objectives: To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake.

Material and methods: Retrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined.

Results: The overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79).

Conclusion: Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.

Keywords: Anatomic Success; Chronic Otitis Media.; Factores pronósticos; Functional Success; Otitis media crónica; Prognostic Factors; Timpanoplastia; Tympanoplasty; Éxito anatómico; Éxito funcional.