A multivariate analysis of otological, surgical and patient-related factors in determining success in myringoplasty

• Published in: Clinical otolaryngology Vol. 30; no. 2; pp. 115 - 120
• Main Authors: Onal, K., Uguz, M.Z., Kazikdas, K.C., Gursoy, S.T., Gokce, H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2005; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Cholesteatoma, Middle Ear - epidemiology; Female; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myringoplasty - methods; Retrospective Studies; Smoking - epidemiology; Socioeconomic Factors; Surgical Flaps; Transplantation, Autologous; Treatment Outcome; Tympanic Membrane Perforation - epidemiology; Tympanic Membrane Perforation - surgery; Valsalva Maneuver
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/j.1365-2273.2004.00947.x

Objectives:  The aim of this study was to evaluate the effects of smoking and other prognostic factors on long‐term surgical outcome and hearing results in myringoplasty.
Design:  Retrospective cohort.
Setting:  Tertiary medical centre.
Participants:  Eighty myringoplasty operations were analysed retrospectively from the charts of 74 patients who underwent myringoplasty between January 2000 and November 2002 at the First ENT Clinic of Atatürk Training and Research Hospital, using the chi‐squared test, Fisher's exact test, t‐test and multiple logistic regression statistical analysis.
Main outcome measures:  The effects of prognostic factors and smoking on myringoplasty were investigated by variables noted from patients’ files such as smoking status, operation type, duration of dry period of the diseased ear, peroperative otorrhoea, status of the opposite ear, presence of perforation at admission, place of perforation, size of perforation, status of middle ear mucosa, presence of cholesteatoma and tympanosclerosis, ossicular status, previous and related surgery, experience of the surgeon, presence of anterior overhang, presence of valsalva manoeuvre, postoperative antiobiotic cover and income per day.
Results:  The overall take rate of the myringoplasty graft was 71%. Based on the univariate analysis, smoking status of the patients (P = 0.008), status of the opposite ear (P = 0.01), size of perforation (P = 0.009) and the experience of the surgeon (P = 0.002) were found to be statistically significant (P < 0.01) prognostic factors influencing the success rate of the operations. Multiple logistic regression analysis was subsequently carried out on these prognostic factors and yielded the following classification (95% CI): senior surgeon (OR = 14.3), non‐smoking patient (OR = 11.4), longer duration of dry period of the diseased ear (OR = 5.3), normal opposite ear (OR = 5.0) and small perforation (OR = 4.8).
Conclusions:  A non‐smoking patient, a longer dry ear, a healthy opposite ear, a relatively smaller perforation and a senior surgeon were found to be significant prognostic factors positively influencing the success rate of myringoplasty.