Impact of Graft Material and Surgical Technique on Frequency-specific Audiometric Outcomes Following Tympanoplasty

Abstract

Objective:

Investigate frequency-specific audiometric outcomes following tympanoplasty without ossiculoplasty using different grafting materials and techniques.

Methods:

A multi-institutional review of patients who underwent tympanoplasty via either medial or lateral graft techniques from May 2017 to August 2022 was performed. Frequency-specific audiometric outcomes were analyzed using multivariable logistic regression.

Results:

A total of 88 patients (93 ears) met criteria (mean age 46 years). Median follow-up was 6.7 ± 6.1 months. Perforation closure was achieved in 87% cases and did not vary between graft materials. Loose areolar fascia (LAF) was used in 32% of tympanoplasties (N = 30) and temporalis fascia (TF) in 48% cases (N = 45). Compared to TF, LAF was associated with better low-frequency (500 and 1 kHz) pure-tone average (PTA) improvement (12.4 dB vs 1.6 dB, P < .001) and air-bone gap (ABG) closure (11.4 dB vs 1.6 dB, P = .003). PTA improvement and ABG closure were superior in medial technique cases compared to lateral technique (P < .001for both). When considering only medial underlay technique, ABG closure were comparable for both grafting materials (9.5 dB in LAF vs 10.5 dB in TF, P = .7). Multivariable logistic regression accounting for graft material, identified surgical technique as a significant predictor of postoperative audiometric outcomes.

Conclusion:

Loose areolar fascia may be associated with better low-frequency hearing than TF following tympanoplasty. However, when using only medial underlay technique, both materials offered similar improvements, suggesting surgical technique may be more crucial than the choice of grafting material.