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Patient Factors Predicting Success in Lateral Graft Tympanoplasty
Zoha K Momin1, Kristen L Yancey1, Tanner J Mitton1
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Objective:
To compare the effects of preoperative medical comorbidities and operative findings on the success of lateral graft tympanoplasty.
Study Design:
Retrospective chart review.
Setting:
Tertiary medical center.
Patients:
Ninety-six patients undergoing lateral graft tympanoplasty from December 2008 to November 2020 with at least 2 months follow-up were included. Patient demographics, comorbidities including smoking status, intraoperative findings, and healing, and hearing outcomes were recorded.
Interventions:
Lateral graft tympanoplasty.
Main Outcome Measures:
The primary outcome was perforation closure. Secondary outcomes were postoperative complications and change in air-bone gap (ABG).
Results:
Ninety-nine ears (mean age 40.94 ± 18.44 years) were included. Tympanic membrane perforation closure was achieved in 92 (92.9%) ears. Perforation closure was not associated with diabetes (P > 0.99), smoking (P > 0.99), or the presence of cholesteatoma at the time of lateral graft tympanoplasty (P = 0.10). Increased age (odds ratio [OR] = 1.04, P = 0.31) was also not correlated with tympanic membrane closure rate. An absent malleus resulted in a higher rate of lateralization (31.3% versus 2.1%; OR = 18.41, 95% confidence interval [CI] = 3.09-95.95, P = 0.001) but not blunting (12.5% versus 4.8%; OR = 0.24, 95% CI = 0.49-12.93, P = 0.24). The mean ABG improved 6.82 ± 11.33 dB (P < 0.01). History of prior tympanoplasty was associated with smaller ABG improvement following surgery (ß = 4.038, R2 = 0.262, P = 0.04) but not perforation closure (OR = 3.25, 95% CI = 0.63-16.81, P = 0.24).
Conclusions:
Diabetes, active smoking, and advancing age were not associated with adverse healing in patients undergoing lateral graft tympanoplasty. Lateralization was more common with an absent malleus.
