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Postoperative Infection in Myringoplasty: Impact of Surgical Technique and Timing of Infection
1Operating Theater, Yiwu Central Hospital, Yiwu city, Zhejiang province, China.
Objective:
We analyzed ear-related factors contributing to postoperative infections after myringoplasty. We also examined the association between the timing of postoperative infections and graft success.
Materials And Methods:
This retrospective study reviewed clinical data and operative records of patients with chronic tympanic membrane (TM) perforations who underwent myringoplasty. Factors influencing postoperative infection, including surgical techniques, perforation size, external auditory canal (EAC) packing, prophylactic antibiotic type, and the application of topical antibiotic cream, were assessed. In addition, the relationship between the timing of postoperative infection and graft failure was evaluated. Postoperative infection time was categorized as 1, 2, 3, or 4 weeks postoperatively.
Results:
In total, 263 patients with chronic TM perforations underwent myringoplasty. The overall postoperative infection rate was 12.2% (32/263). The modified over-underlay approach was associated with a postoperative infection rate of 19.0%, in contrast to 11.1% for the conventional over-underlay technique and 8.9% for the underlay technique (P = .081). No significant differences in postoperative infection rates were identified among the NasoPore packing group (10.9%), the erythromycin cream group (19.4%), and the no-packing group (11.9%) (P = .418). Similarly, no significant differences were observed between prophylactic antibiotic type (11.2% vs 12.2% vs 25.0%, P = .373) or between the patients with and without topical antibiotic ointment (12.4% vs 10.3%, P = .986). Among the 32 patients with postoperative infections, 21.9% achieved graft success, whereas 78.1% experienced graft failure. Graft success rates were 71.4% (5/7), 9.1% (2/22), and 0.0% (0/3) at 1, 2, and 3 weeks postoperatively, respectively (P < .01).
Conclusions:
Our findings suggest that prophylactic antibiotic type, perforation size, the use of topical erythromycin cream, and EAC packing do not significantly influence postoperative infection. However, the surgical technique may affect the risk of postoperative infection. In addition, the timing of postoperative infection may influence graft failure.
Insights
Surgical technique may impact postoperative infections after myringoplasty, but antibiotic type and topical treatments do not. Early infection timing is linked to higher graft failure rates, highlighting the importance of surgical approach in preventing complications.
Area of Science:
- Otolaryngology
- Surgical Infections
- Myringoplasty Outcomes
Background:
- Chronic tympanic membrane perforations often require surgical repair via myringoplasty.
- Postoperative infections are a significant complication that can impact graft success.
- Understanding factors influencing these infections is crucial for improving surgical outcomes.
Purpose of the Study:
- To identify ear-related factors contributing to postoperative infections following myringoplasty.
- To examine the association between the timing of postoperative infections and graft success.
Main Methods:
- Retrospective review of clinical data and operative records for 263 patients undergoing myringoplasty for chronic tympanic membrane perforations.
- Assessment of factors including surgical techniques (modified over-underlay, conventional over-underlay, underlay), external auditory canal (EAC) packing, prophylactic antibiotic type, and topical antibiotic cream use.
- Evaluation of the relationship between postoperative infection timing (1, 2, 3, or 4 weeks) and graft failure.
Main Results:
- The overall postoperative infection rate was 12.2%.
- The modified over-underlay surgical technique showed a trend towards higher infection rates (19.0%) compared to conventional over-underlay (11.1%) and underlay (8.9%) techniques (P = .081).
- No significant differences in infection rates were found based on EAC packing, topical erythromycin cream, or prophylactic antibiotic type.
- Graft success rates were significantly lower in patients with infections occurring later postoperatively (71.4% at 1 week vs. 9.1% at 2 weeks vs. 0.0% at 3 weeks; P < .01).
Conclusions:
- Prophylactic antibiotic type, perforation size, topical erythromycin cream, and EAC packing do not appear to significantly influence postoperative infection risk after myringoplasty.
- Surgical technique, specifically the modified over-underlay approach, may be associated with an increased risk of postoperative infection.
- The timing of postoperative infection is a critical factor, with later infections strongly correlating with graft failure.
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