Prognostic factors in tympanoplasty

OBJECTIVE: To assess the prognostic value of pathologic and technical variables influencing the functional outcome of tympanoplasty. PATIENTS AND STUDY DESIGN: Retrospective review of the records of 544 patients affected by chronic otitis with or without cholesteatoma, operated on by the senior author in a city hospital ENT department. Follow-up was provided systematically by the same institution. INTERVENTIONS: These included tympanoplasty without mastoidectomy in 339 cases, canal wall up technique in 134 cases, and canal wall down in 71 cases. Three hundred twenty-six (60%) were primary, and 218 (40%) were revision procedures. Myringoplasty was performed with autologous temporalis fascia, ossiculoplasty with incus interposition, or partial or total ossicular prostheses. Mean follow-up was 14 months (range, 12-50 months). MAIN OUTCOME MEASURES: Hearing results were defined according to the Committee on Hearing and Equilibrium Guidelines. A one-way analysis of variance was used to determine group differences. Multiple logistic regression analysis was subsequently carried out on the different pathology groups via the hierarchical log linear model. A probability value of p < 0.05 was the level of significance. RESULTS: The status of the mucosal lining, the mastoidectomy, the availability of the malleus handle, and the tympanic membrane perforation were all significantly predictive of the hearing outcome but with differing weight according to the pathologic condition. CONCLUSIONS: Anatomic and technical factors diversely affect the functional outcome of tympanoplasty. A better knowledge of their predictive roles and weights may be useful in both the surgeon's judgment and in the information given to the patient.