Unsuccessful Healing of Tympanic Membrane Perforations Following Myringoplasty—A Nationwide Retrospective Study

INTRODUCTION: Risk factors for unsuccessful healing of a tympanic membrane perforation following myringoplasty lack consensus. Large cohort studies are missing. METHODS: Data were collected for myringoplasties (with/without concomitant ossiculoplasty) performed the years 2014-2019 with a follow-up visit using the Swedish Quality Register for Ear Surgery (SwedEar). Risk factors for unsuccessful surgical outcome, defined as non-healed tympanic membrane at follow-up, were calculated using logistic regression. RESULTS: The study population included 3622 cases and 12.8% had a non-healed tympanic membrane at follow-up. The most commonly used graft material was fascia, used in 94.6% of the cases. Of the analysed variables, prior ear surgery (adjusted (a)OR 1.43, p = 0.005), age younger than 8 years (aOR 1.73, p = 0.015), a postoperative infection within 6 weeks after surgery (aOR 1.92, p < 0.001) and the surgical aim of achieving a dry/infection free ear (aOR 1.53, p = 0.045) were predictors for unsuccessful healing. For simultaneous ossiculoplasty at surgery, there was a significantly higher chance of having a healed tympanic membrane (aOR 1.49, p = 0.016). For other variables such as gender, operated side, season, graft material, perioperative antibiotics and infection free status at surgery, there was no significant effect on tympanic membrane healing. CONCLUSION: The present evaluation of the surgical results in SwedEar constitutes one of the largest studies on myringoplasty outcome. The results showed that the age of the patient, surgical aim, prior ear surgery and postoperative infection constituted risk factors for unsuccessful healing after myringoplasty. Surprisingly, ears requiring a concomitant ossiculoplasty had a higher healing rate.