[Long-term results and an analysis of surgically related factors in myringoplasty with sandwich method]

Objective To evaluate the effect of the prognostic factors on long-term surgical outcome in myringoplasty. Methods Retrospective cohort 205 patients （223 ears） with sandwich temporal fascia myringoplasty were analyzed using the multiple logistic regression analysis. The charts of inpatients had undergone myringoplasty before at least 2 years between January 1999 and November 2003 at Beijing Tongren Hospital. Postoperative follow-up rate was 78.2%. Their ages ranged from 12 to 65 years （ mean = 34. 3 years）. Their durations of disease ranged from 1 month to 25 years （mean = 16.07 months）. The effect of prognostic factors on myringoplasty were investigated by variables noted from patients' files such as age,sex, causes of disease, duration of disease, period of dry ear of disease, operation types, places of tympanic membrane perforation, size of tympanic membrane perforation, status of middle ear and status of eardrum. Results There were 11 ears with reperforation of eardrum at the last follow-up. Successful closure of the tympanic membrane perforation was obtained in 95. 1% of the ears （212 ears）with 2 to 5 years follow-up. There were 26 ears with other complications at the last follow-up. Operations were successful in 186 patients. The overall take rate of the myringoplasty was 83.4%. Multiple logistic regression analysis （ward） was subsequently carried out on these prognostic factors on overall take rate of the myringoplasty and yielded the following classification. Relative importance of the predictive variables was as follows： size of tympanic membrane perforation （ OR = 1. 900）, duration of disease （OR=1.003 ） and period of dry ear of disease （ OR = 0. 908）. Hearing outcomes： the average air-bone gap improvement was 7. 0 dB and the average air conduction improvement was 6. 8 dB for all 175 myringoplasty procedures. Conclusions A long term follow-up was important. Late atelectatic pocket was a late complication and a cause of failure. A relatively smaller tympanic membrane perforation, a relatively shorter duration of disease and a relatively longer period of dry ear of disease were found to be significant prognostic factors positively influencing the success rate of myringoplasty. Key words: Tympanic membrane perforation; Myringoplasty; Ear diseases