Risk stratification in endoscopic type I. tympanoplasty

Area of Science:

• Otolaryngology
• Surgical Innovation
• Medical Risk Assessment

Background:

• Endoscopic type I tympanoplasty is a common procedure for middle ear reconstruction.
• Existing risk factors for surgical success are known, but a comprehensive stratification model is lacking.
• Accurate prediction of outcomes is crucial for patient management and surgical planning.

Purpose of the Study:

• To develop and validate an easy-to-use risk stratification model for endoscopic type I tympanoplasty.
• To identify key predictors of surgical success and failure in this procedure.
• To improve patient selection and counseling based on individual risk profiles.

Main Methods:

• Retrospective chart review of patients undergoing endoscopic type I tympanoplasty.
• Analysis of individual risk factors, including middle ear risk index (MERI), perforation size, and preoperative air-bone gap (ABG).
• Development of a risk stratification model incorporating these factors.

Main Results:

• Successful closure of the tympanic cavity was achieved in 88.1% of cases.
• The average reduction in air-bone gap (ABG) was 9.8 dB.
• Perforation size and preoperative ABG were significant predictors of success; MERI status alone was not.
• A model combining perforation size, preoperative ABG, and MERI stratified patients into distinct risk groups, with higher risk associated with two or three factors.

Conclusions:

• Endoscopic type I tympanoplasty with perichondrium graft offers a good chance of success.
• The presence of multiple risk factors, particularly perforation size and preoperative ABG, significantly increases the likelihood of residual perforation.
• The developed risk stratification model can help predict outcomes and guide clinical decision-making.