Determinants influencing success rates of myringoplasty in daily practice: a retrospective analysis

Objectives The aim of this study was to determine influencing factors on tympanic membrane closure and their consequence on absolute risks of closure and hearing improvement in myringoplasties. Design Retrospective cohort. Setting Medium-sized medical centrum. Participants 195 patients were analysed who underwent a myringoplasty between January 2015 and February 2017 at the Jeroen Bosch Hospital in The Netherlands. Main outcome measures Patient-related data, descriptions of the tympanic defect, surgical data, and the most important follow-up data were collected. Primary outcome is successful closure of the tympanic membrane and the secondary outcome is the amount of air–bone gap improvement after surgery. Results The overall success rate of the myringoplasty graft was 74.9%. If cartilage and butterfly graft were used, higher success rates of 85.4% and 85.5% were achieved compared to temporalis fascia (61.3%). Success rate of the operation was dependent of the skills of the surgeon. Chances of success are 91.9% if the operation is performed by an experienced surgeon using cartilage and 66.7% if a less experienced surgeon uses fascia. If a postoperative complication occurs or when silastic sheets are used, this might have a negative effect on the success of the operation. The mean ABG improved 10.10 dB if the perforation was closed compared to 3.38 dB after an unsuccessful procedure. Conclusion The success rate of a myringoplasty is dependent of the skills of the surgeon and type of graft used and varies between 91.9 and 52.0% depending on these factors.