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Anales de Otorrinolaringología Mexicana

2009, Number 2

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Otorrinolaringología 2009; 54 (2)

Smoking effects on tympanoplasty surgical results

Molina PH, García EB

Language: Spanish
References: 28
Page: 45-50
PDF size: 456.45 Kb.


ABSTRACT

Background: In case of a tympanic perforation due to chronic infections or trauma, the goal of tympanoplasty is to remove the afection with a functional auditory system and an intact tympanic membrane. The success index of tympanoplasty regarding the integrity of the graft is variable, reported from 73.6 to 97%. It has been identified as a factor of bad prognosis the size of the perforation, presence of othorrea, location of the perforation, technique and approach; but conclusions related to smoking are contradictory.
Objectives: To determine the relation between tympanic graft perforation after tympanoplastia and smoking, in comparison with integral graft; and to confirm if smoking is a risk factor of adverse surgical results of middle ear diseases.
Material and methods: This is a case-control study where 91 tympanoplasties were made in 60 patients and 85 cases were followed at least three months: 28 (46%) men and 32 (54%) women. Patients with a previous diagnosis of chronic otitis media or traumatic rupture of the tympanic membrane, who had a tympanoplasty from 2003 to 2006 and had a postoperative graft perforation, were identified and searched for a prevalence of smoking habit, as well as other risk factors that may have affected the integrity of the graft. In the control group patients with a history of tympanoplasty and a mean follow-up of 3 months with a healthy complete tympanic graft were included.
Results: Twenty-six (30.6%) cases were found with a perforated graft, 59 (69.4%) with a complete tympanic graft which were used as controls. Thirty-six had a previous history of smoking with a total of 16 (44.4%) with a graft perforation (OR: 3.12). Forty nine patients were non-smokers and 10 (20.4%) of them had a perforation. When comparing those with an average of 10 or more cigarette per day (12 cases) that presented a perforation (10 = 83.33%) with the control group we found an OR of 19.56. There is a greater risk of graft perforation in active smokers than in those who quitted the habit (OR: 3.30) as in those who had a package index of more than 10 per year (OR: 15.00).
Conclusion: Smoking increases the chance of a tympanic graft perforation after tympanoplasty with bigger risk to whom smoke more than 10 ci- garettes per day. Previous otologic surgery, grafts with Alloderm, ossiculoplasty, endomeatal approach and ear pathology evolution by 20 years showed to be meaningful.


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