Surgical Aspects Influencing Tympanoplasty Outcomes

Background: Tympanoplasty (TP) is a surgical procedure that aims to repair a persistently perforated eardrum via grafting. Different surgical techniques and graft materials were used for TP with variable success rates. Purpose: This study aims to determine predictors of failure of TP and compare different graft materials used. Materials and Methods: Retrospective review of all the medical records of patients that underwent tympanoplasties at King Abdulaziz University Hospital from 2011 to 2013. Predicting factors included smoking, associated comorbidities, past ear surgeries, symptoms, anatomy and cause of perforation, primary or revision, type of TP, technique, approach, usage of packing and graft materials (fascia, cartilage or allograft). Outcome of success was measured clinically by graft take-up and degree of air-bone gap (ABG) closure. Results: A total of 80 cases were reviewed, and analysis showed no difference between graft types’ success rate. The underlay surgical technique had a statistically significant better success rate (85.7%) compared the overlay technique (55.6%) (p=0.03). No other risks for failure were identified from our variables. ABG closure was best at hearing frequencies 250, 500 and 1k Hz. ABG closure at 2k and 4k Hz was not statistically significant. Conclusions: Graft type has no significant effect on clinical outcome. Underlay technique is superior to overlay with a higher success rate. Functional hearing improvement after TP can be expected after surgery.