Comparison of Hearing Outcomes in Tympanoplasty With and Without Ossiculoplasty: A Retrospective Cohort Study

Abstract

Objectives To examine the ability of the Middle Ear Risk Index (MERI) score components in order to predict postoperative air-bone gap (ABG) and success rate in patients who underwent tympanoplasty. Methods A retrospective cohort study was conducted at King Hamad University Hospital between May 2017 and February 2021. A total of 79 patients were divided into two groups: 42 patients (53.2%) underwent tympanoplasty without ossiculoplasty, and 37 patients (46.8%) underwent tympanoplasty with ossiculoplasty. Data collected included demographic information, four-frequency ABG pre- and post-surgery, and total MERI scores. Statistical analyses included paired sample t-tests to assess changes in ABG and chi-square tests to evaluate associations between categorical variables. A p-value of <0.05 was considered significant. Results Seventy-nine patients were evaluated. Over half (53.2%) underwent myringoplasty only, and 46.8% (n = 37) underwent tympanoplasty with ossiculoplasty. Post-operative ABG was highly correlated with the presence of cholesteatoma, ossicular chain score, and the presence of previous surgery. The MERI score was correlated with the postoperative ABG gap, but with a relatively poor correlation coefficient, making it nonpractical for clinical use. Ossicular chain score alone was a better indicator of postoperative ABG. Successful closure of ABG was high in both groups, reaching 83.6% (n = 31) in the ossiculoplasty group and 92.8% (n = 39) in the myringoplasty group. Some components of the MERI score were found to be significantly interrelated, making the MERI score not a reliable prognostic indicator. Patients who underwent tympanoplasty with ossiculoplasty had high pre- and postoperative ABG values (27.47 ± 14.22 and 15.02 ± 8.58, respectively). The mean total MERI score (5.56 ± 2.24) was also significantly higher in patients who underwent ossiculoplasty. Conclusions Our findings indicate that both cholesteatoma and ossicular pathology significantly influence hearing outcomes, with a high degree of interrelation. While the MERI provides some insight, its limited predictive value, due to the interdependence of its components, suggests that it may not be a reliable tool for clinical decision-making in tympanoplasty and ossiculoplasty.