title: Lateral tympanoplasty for total or near-total perforation: prognostic factors.
abstract: OBJECTIVE
  To identify prognostic factors affecting outcome in lateral tympanoplasty for total or near-total tympanic membrane perforation.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Patients were those presenting with total or near-total tympanic membrane perforation undergoing lateral tympanoplasty from 1999 to 2004. We systematically collected demographic, clinical, audiologic, and outcome information. Student t test was used to determine group differences. Logistic regression analysis was used to examine the relationship between success of grafting (dependent variable) and the independent variables. Multiple regression analysis was used to examine the relationship between postoperative air-bone gap (ABG) and independent variables.
  
  
  RESULTS
  There were seventy-seven cases (58 primary and 19 revision cases) with average follow-up of 17 months. Successful tympanic membrane grafting occurred in 91% of cases. None of the independent variables studied was predictive of the success of graft incorporation (P > .05). The mean preoperative ABG was 29.8 +/- 10 dB and improved to a postoperative ABG of 16.5 +/- 11 dB (P < .001). Smaller preoperative ABG and normal malleus handle were associated with smaller postoperative ABG. In revision cases, mastoidectomy was associated with better functional results.
  
  
  CONCLUSIONS
  Successful grafting of near-total and total tympanic membrane perforations occurred in 91% of the cases and was independent of demographic, disease, and technical variables. Disease variables (preoperative ABG and status of malleus handle) had a greater prognostic value on postoperative ABG than other variables. In revision tympanoplasty, mastoidectomy is associated with a better functional outcome.
authors.affiliation: Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA. sangeli@med.miami.edu
authors.forename: Simon I
authors.initials: SI
authors.lastname: Angeli
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Kulak
authors.forename: Jose
authors.initials: J
authors.lastname: Guzmán
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000209:etiology / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*