Smoking and tympanoplasty: Implications for prognosis and the Middle Ear Risk Index (MERI)

Objectives/Hypothesis: The objectives of this study are to review the effec ts of smoking on preoperative middle ear disease severity, long-term surgic al outcome, type and extent of surgery required, the need for ossicular cha in reconstruction, and the long-term hearing results. Study Design A retros pective chart review. Materials and Methods. The charts of 74 smokers and n on-smokers who underwent over-under tympanoplasty were reviewed. An analysi s of the disease severity (using the Middle Ear Risk Index [MERI]) at prese ntation and type of surgery was performed. A review of graft take and delay ed failure (late perforation or atelectasis after 6 mo) and audiologic data were performed. Results. Fifteen patients smoked a mean of 20 cigarettes d aily for a mean of 15 years. The MERI was well matched for both groups. The re was a trend toward smokers having a higher incidence of otorrhea preoper atively and requiring a more extensive surgical procedure. All patients had fall take of the tympanic membrane graft at 6 months; however, delayed sur gical failure was seen in 20% of non-smokers compared with 60% of smokers ( P = .050). No statistically significant difference was seen in hearing outc ome. Conclusions: Cigarette smoking is associated with more severe middle e ar disease preoperatively. More extensive surgery is often needed in smoker s to eradicate the disease. Most significantly, smoking is associated with a threefold increase in the chance of long-term graft failure. Based on the results of this study, the MERI has been revised to include smoking as a r isk factor.