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Smoking and Tympanoplasty: Implications for Prognosis and the Middle Ear Risk Index (MERI)
Author(s) -
Becvarovski Zoran,
Kartush Jack M.
Publication year - 2001
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200110000-00026
Subject(s) - medicine , tympanoplasty , middle ear , surgery , atelectasis , perforation , incidence (geometry) , retrospective cohort study , disease , lung , materials science , physics , optics , punching , metallurgy
Objectives/Hypothesis The objectives of this study are to review the effects of smoking on preoperative middle ear disease severity, long‐term surgical outcome, type and extent of surgery required, the need for ossicular chain reconstruction, and the long‐term hearing results. Study Design A retrospective chart review. Materials and Methods The charts of 74 smokers and non‐smokers who underwent over–under tympanoplasty were reviewed. An analysis of the disease severity (using the Middle Ear Risk Index [MERI]) at presentation and type of surgery was performed. A review of graft take and delayed failure (late perforation or atelectasis after 6 mo) and audiologic data were performed. Results Fifteen patients smoked a mean of 20 cigarettes daily for a mean of 15 years. The MERI was well matched for both groups. There was a trend toward smokers having a higher incidence of otorrhea preoperatively and requiring a more extensive surgical procedure. All patients had full take of the tympanic membrane graft at 6 months; however, delayed surgical failure was seen in 20% of non‐smokers compared with 60% of smokers ( P = .050). No statistically significant difference was seen in hearing outcome. Conclusions Cigarette smoking is associated with more severe middle ear disease preoperatively. More extensive surgery is often needed in smokers 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 risk factor.