Preoperative hearing predicts postoperative hearing

Optimal hearing is one goal of otologic surgery. It is generally presumed t hat hearing thresholds after tympanoplasty-mastoidectomy surgery are determ ined by remaining anatomy. We assessed the effect of the disease process on hearing after surgery, and our data do not support this presumption. We st udied the relationship between preoperative and postoperative hearing acros s tympanoplasties with differing anatomies in 124 patients without ossicula r reconstruction with prostheses or bone. Our results indicate that poor he aring before surgery is associated with poor hearing after surgery, regardl ess of anatomy (type of tympanoplasty). This relationship holds for both th e air-bone gap and the speech-reception threshold. When considering ossicul ar reconstruction, the surgeon should remember that the disease process its elf affects hearing in addition to the physical attributes of the ear. Thes e results should be considered in preoperative counseling, as well as in th e interpretation of the otologic literature.