Predictive Factors of Surgical Success in Endoscopic Tympanoplasty for Chronic Otitis Media

OBJECTIVE: This study aimed to identify predictors of surgical success in patients with non-cholesteatomatous chronic otitis media (COM) undergoing endoscopic tympanoplasty. METHODS: Patients who underwent endoscopic tympanoplasty for COM without cholesteatoma between January 2012 and December 2023 were retrospectively reviewed. Primary outcomes were graft success and the combined outcome of intact tympanic membrane with hearing (postoperative air-bone gap [ABG] < 15 dB). Descriptive statistics and logistic regression analyses were used to identify predictors. RESULTS: Among 301 cases, graft integrity at 12 months was achieved in 82.4%. The mean ABG improved from 22.8 to 9.8 dB. The use of perichondrium (OR = 3.67; 95% CI, 1.22-15.88) and cartilage (OR = 2.31; 95% CI, 1.02-5.81) grafts was significantly associated with higher rates of graft take compared with temporalis fascia. Predictors of reduced graft success included untreated rhinitis (OR = 0.25; 95% CI, 0.07-0.81), persistent otorrhea (OR = 0.18; 95% CI, 0.03-0.97), and inferior external auditory canal bony overhang (OR = 0.17; 95% CI, 0.04-0.79). Considering combined graft take and hearing outcomes, preoperative ABG ≤ 30 dB was a significant predictor of favorable outcomes, whereas untreated rhinitis, persistent otorrhea, and middle ear swelling were negative predictors. CONCLUSION: Endoscopic tympanoplasty is an effective treatment for COM without cholesteatoma. Surgical graft success was enhanced by selecting durable graft materials, particularly cartilage or perichondrium, maintaining a dry ear, controlling rhinitis, and addressing anatomical challenges such as canal overhangs. Both graft uptake and hearing improvement were strongly influenced by preoperative ABG and nasal and middle ear conditions.