Preventing or reducing smoking-related complications in otologic and neurotologic surgery

To discuss effects of smoking on otologic surgery in an era of electronic (e-) cigarettes and proposals for legalization of marijuana. Physiologic mechanisms and clinical outcomes are presented.

Tobacco smoke can cause a variety of tissue effects that may adversely impact otologic surgery outcomes. Results in tympanoplasty using temporalis fascia are inferior in smokers compared with nonsmokers. More recent data show that in cartilage tympanoplasty, graft incorporation rates in smokers may approach those of nonsmokers. However, these results may not be as durable long-term in smokers. Evidence from nonotologic studies suggests that smoking cessation and nicotine replacement therapy may reduce perioperative morbidity. No data are available on electronic cigarettes and otologic outcomes; however, based on the pathophysiologic mechanisms of tobacco smoking, electronic cigarettes are likely a safer alternative. Marijuana smoke also needs to be considered as more states consider legalization.

Cigarette smoking negatively influences otologic surgery results, mostly because of tobacco combustion byproducts. Counseling and, if needed, pharmacologic measures to reduce smoking are recommended. E-cigarettes that deliver nicotine in water vapor may be safer than tobacco smoking. Our review contributes to the discussion of how the trends of e-cigarette use and marijuana legalization will unfold in the future to affect our patients' outcomes.