Study of Various Prognostic Factors Affecting Successful Myringoplasty in a Tertiary Care Centre

Abstract

Introduction Myringoplasty is a commonly performed otologic surgery. Objectives The objective of this study is to evaluate the effect of prognostic factors like - size, site of perforation, status of operating ear, approach, status of contralateral ear, experience of surgeon, primary or revision myringoplasty, and smoking in graft uptake, as well as to evaluate the hearing results after myringoplasty. Methods This is a prospective study. We included in our sample patients aged over 13 years with a Tubotympanic Chronic Otitis Media diagnosis. The patients underwent preoperative evaluation and Pure Tone Audiogram within one week prior to surgery. We performed myringoplasty using temporalis fascia graft with conventional underlay technique. We evaluated postoperative graft uptake and various factors related to the study and did a Pure Tone Audiogram at one year after surgery. Results The graft uptake rate after myringoplasty was 83.1% at one year in 219 patients. Graft uptake with normal opposite ear was 88.2%, and with Tubotympanic Chronic Otitis Media was 75% (statistically significant). We found no statistically significant difference in graft uptake results with other factors. We calculated hearing results of 132 patients with normal ossicular status who underwent myringoplasty. The average Air Conduction Threshold improvement was 11.44dB ( p < 0.001) and the average Air-Bone Gap closure was 8.89dB, highly statistically significant ( p < 0.001). Conclusion Diseased contralateral ear was a statistically significant poor prognostic factor for graft uptake after myringoplasty. Other factors studied were not statistically significant determining factor for graft uptake. Hearing improves significantly after myringoplasty if the ossicles are normal.

Type 1 tympanoplasty: does the status of contralateral ear affect the outcome?

“…Middle ear effusion poor when the contralateral ear had tubotympanic disease (p<0.05). 21 However, in contrary to our findings and the studies mentioned above, Albera et al and Chandrasekhar et al found no statistical relationship between the condition of the contralateral ear and the final surgical outcome. 22,23 There is broad consensus about the importance of tubal function in the outcome of tympanoplasty.…”

Evaluating short and long term outcomes following pediatric Myringoplasty with Gelfoam graft for tympanic membrane perforation following ventilation tube insertion

“…Regarding parameters influencing surgical outcomes, our results are in keeping with previous studies depicting the majority of variables do not cause a significant effect on outcomes [4, 7, 16, 17]. A large retrospective study of 341 pediatric cases found no difference in TMP rates by patient sex, indication for tube removal, required number of set of tubes or duration of tube retention [4].…”

A study of factors affecting the success rate of type-1 tympanoplasty

“…All patients had a postoperative air-bone gap of less than 20 dB at 3 months of follow-up (Table 7). 3,5,7 In our study, the youngest patient was of 20 years and oldest patient was of 60 years. Mean age was 32.36±11.02 years.…”

“…In Kripa et al study, permeatal approach was used more commonly. 5 In our study, the most common technique used for grafting was underlay (61%), followed by overlay (24%), and interlay (15%). In a study by Sergi et al, overlay technique of grafting was most commonly used and results showed a better hearing gain in the underlay group.…”

“…4 Another study from Nepal done in 2017 suggested that diseased contralateral ear was a statistically poor prognostic factor for graft uptake after myringoplasty. 5 An Indian study done in 2015 showed that site of perforation did not affect the results of tympanoplasty. 6 Our hospital caters to a vast population of Kachchh district of western Gujarat.…”