Determinants of Failure in the Reconstruction of the Tympanic Membrane: A Case-Control Study.

Introduction: The recurrence rate after tympanoplasty is variable between 0% and 50%. The causes of failure may be different and frequently interrelated, making the surgical choice difficult and the prognosis not always favourable. In this study, we analysed recurrence rate and the possible causes of failure of tympanoplasty in the treatment of tympanic perforations.

Materials and Methods: This prospective case-control study was carried out on patients undergoing tympanoplasty. The main outcome was closure of the tympanic membrane.

Results: Among the studied 72 patients, the overall recurrence rate was 19.4%. The average follow-up was 28 months; no recurrence was observed over 12 months of follow-up. We observed a recurrence of 30.7% (OR 2.9) in near total perforations. In 32 subjects with a perforation of over half size of the membrane, a recurrence rate of 31.2% was noted (OR 4.09; P< 0.05). In 22 out of the 72 patients, there was a bilateral chronic otitis where the rate of recurrence was 27.2% (OR 1.9). During the postoperative period, 10 patients contracted infection of the middle/external ear, and in all of these cases failure of the surgical intervention was recorded (P<0.01).

Conclusion: The rate of recurrence is closely related to several factors that may be concomitant and therefore, worsen the prognosis. Perforations that affect more than 50% of the tympanic surface are related to a higher rate of failure and are often associated with one of the two conditions previously described. Postoperative infection is the most significant risk factor for recurrence.