Determinants of Failure in the Reconstruction of the Tympanic Membrane: A Case-Control Study

Document Type: Original

Authors

1 Department of Otorhinolaryngology, A.O.U.P. “Paolo Giaccone”, Palermo, Italy.

2 Department of Bio.Ne.C, University of Palermo, Palermo, Italy.

Abstract

Introduction:
The recurrence rate after tympanoplasty is variable between 0% and 50%. The causes of failure may be different and frequently interrelated, making the surgical choice difficult and the prognosis not always favourable. In this study, we analysed recurrence rate and the possible causes of failure of tympanoplasty in the treatment of tympanic perforations.
 
Materials and Methods:
This prospective case-control study was carried out on patients undergoing tympanoplasty. The main outcome was closure of the tympanic membrane.
 
Results:
Among the studied 72 patients, the overall recurrence rate was 19.4%. The average follow-up was 28 months; no recurrence was observed over 12 months of follow-up. We observed a recurrence of 30.7% (OR 2.9) in near total perforations. In 32 subjects with a perforation of over half size of the membrane, a recurrence rate of 31.2% was noted (OR 4.09; P< 0.05). In 22 out of the 72 patients, there was a bilateral chronic otitis where the rate of recurrence was 27.2% (OR 1.9). During the postoperative period, 10 patients contracted infection of the middle/external ear, and in all of these cases failure of the surgical intervention was recorded (P<0.01).
 
Conclusion:
The rate of recurrence is closely related to several factors that may be concomitant and therefore, worsen the prognosis. Perforations that affect more than 50% of the tympanic surface are related to a higher rate of failure and are often associated with one of the two conditions previously described. Postoperative infection is the most significant risk factor for recurrence.
 

Keywords

Main Subjects


1. Ringenberg JC. Closure of tympanic membrane perforations by the use of fat. Laryngoscope. 1978; 88(6):982-93.

2. Wullstein H. Theory and practice of tympanoplasty. Laryngoscope. 1956;66:1076–93.

3. Mudry A. History of myringoplasty and tympanoplasty type I. Otolaryngol Head Neck Surg. 2008; 139:613–4.

4. Tan HE, Santa Maria PL, Eikelboom RH, Anandacoomaraswamy KS, Atlas MD. Type I Tympanoplasty Meta-Analysis: A Single Variable Analysis. Otol Neurotol. 2016;37(7):838-46.

5. Kouhi A, Khorsandi Ashthiani MT, Jalali MM. Results of Type I Tympanoplasty Using Fascia with or without Cartilage Reinforcement: 10 Years' Experience. Iranian journal of otorhinolaryngology. 2018; 30(97):103-6.

6. Salviz M, Bayram O, Bayram AA, Balikci HH, Chatzi T, Paltura C, et al. Prognostic factors in type I tympanoplasty. Auris Nasus Larynx. 2015;42(1):
20-3.

7. Uguz MZ, Onal K, Kazikdas KC, Onal A. The influence of smoking on success of tympanoplasty measured by serum cotinine analysis. Eur Arch Otorhinolaryngol. 2008;265(5):513-6.


8. Gibb AG, Chang SK. Myringoplasty (a review of 365 operations). J Laryngol Otol. 1982;96:915–30.

9. Vartiainen E, Karja J, Karjalainen S, Harma R. Failures in myringoplasty. Archives of oto-rhino-laryngology. 1985;242(1):27-33.

10. Jurovitzki I, Sade J. Myringoplasty: long-term followup. Am J Otol. 1988; 9: 52-5.

11. Y AW, White B. Type I tympanoplasty: influencing factors. Laryngoscope. 1984;94:916–8.

12. Ophir D, Porat M, Marshak G. Myringoplasty in the pediatric population. Arch Otolaryngol Head Neck Surg. 1987;113:1288–90.

13. Uzun C, Caye-Thomasen P, Andersen J, Tos M. Eustachian tube patency andvfunction in tympanoplasty with cartilage palisades or fascia after cholesteatoma surgery. Otol Neurotol. 2004; 25:
864–72.

14. Hair Krishna P, Sobha Devi T. Clinical study of influence of prognostic factors on the outcome of tympanoplasty surgery. J Dent Med Sci. 2013; 5:
41–5.

15. Dispenza F, Bennici E, Bianchini S, Scarnà CG, Costantino C, Singh M, et al. Fat plug myringoplasty: Analysis of a safe procedure for small tympanic perforations. EuroMediterranean Biomedical Journal. 2015;10(3):87-92.

16. Heo KW. Outcomes of type I tympanoplasty using a cartilage shield graft in patients with poor prognostic factors. Auris Nasus Larynx. 2017; 44(5): 517-21.

17. de Freitas MR, de Oliveira TC. The role of different types of grafts in tympanoplasty. Braz J Otorhinolaryngol. 2014;80(4):275-6.

18. Yegin Y, Celik M, Koc AK, Kufeciler L, Elbistanli MS, Kayhan FT. Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol. 2016;82(6):695-701.