Prognostic factors in tympanoplasty

Objective: To assess the prognostic value of pathologic and technical varia bles influencing the functional outcome of tympanoplasty. Patients and Study Design: Retrospective review of the records of 544 patie nts affected by chronic otitis with or without cholesteatoma, operated on b y the senior author in a city hospital ENT department. Follow-up was provid ed systematically by the same institution Interventions: These included tympanoplasty without mastoidectomy in 339 ca ses, 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 p rocedures. Myringoplasty was performed with autologous temporalis fascia, o ssiculoplasty with incus interposition, or partial or total ossicular prost heses. Mean follow-up was 14 months (range, 12-50 months). Main Outcome Measures: Hearing results were defined according to the Commit tee on Hearing and Equilibrium Guidelines. A one-way analysis of variance w as used to determine group differences. Multiple logistic regression analys is was subsequently carried out on the different pathology groups via the h ierarchical log linear model. A probability value of p < 0.05 was the level of si,significance. Results: The status of the mucosal lining, the mastoidectomy, the availabil ity of the malleus handle, and the tympanic membrane perforation were all s ignificancy predictive of the hearing outcome but with differing weight acc ording 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 informatio n given to the patient.