Tympanoplasty Healing Outcomes With Use of Postoperative Otic Quinolones

Abstract

Objective Tympanoplasty usually results in tympanic membrane perforation (TMP) closure, but healing may be suboptimal (e.g., excess scarring). Factors that have been linked to impaired TM healing have become widely adopted (especially, postoperative use of quinolone ear drops). The aim of this study is to assess the frequency of suboptimal tympanoplasty healing with the use of otic quinolones postoperatively. Study Design Retrospective chart review. Setting Tertiary care facility. Patients One hundred patients undergoing tympanoplasty for TMP. Intervention(s) Tympanoplasty +/− canalplasty. Main Outcome Measure(s) Healing complications (e.g., granulation tissue, TMP, myringitis, bone exposure, lateralization, anterior blunting, medial canal fibrosis, and canal stenosis) and hearing loss. Methods Charts were reviewed for postoperative healing issues and hearing outcomes at 1 to 2 years postoperatively. Results TMP closure was found in 93.2%, but 34.2% had healing issues at 1 to 2 years postoperatively, with 20.6% having adverse healing outcomes (perforation (6.9%), granulation tissue (6.9%), medial fibrosis (4.1%), and myringitis, bone exposure, and webbing (all 1.4%). Another 13.7% had notable postoperative issues, such as protracted otorrhea (11.0%), otitis externa (9.6%), otitis media (1.4%), and atelectasis (2.7%). No medical, surgical, or patient factors impacted outcomes. Average air–bone gap at 1 to 2 years did not differ between patients with and without healing issues and patients with other postoperative issues (p = 0.5). Conclusions Suboptimal healing is common after tympanoplasty. There may be significant opportunity to improve post-tympanoplasty healing beyond improving the TMP closure rate.

Microbiome and Otic Quinolone Levels Following Tympanoplasty Assessed by Gelatin Sponge Analysis

“…Suboptimal healing is not uncommon following tympanoplasty. 6 Identifying simple, noninvasive techniques to study post-tympanoplasty wound healing could facilitate innovative research in this area. Toward this end, we evaluated the potential use of AGS to assess 2 key aspects of wound healing, microbial burden, and quinolone concentration.…”

“…3 Tympanoplasty successfully closes the TMP in the vast majority of cases in most series 4,5 ; however, persistent TMPs have been reported in up to 35% and other adverse healing outcomes may be equally common. 6 There have long been concerns about the impact of both microbial burden 7,8 and otic preparations on tympanic membrane (TM) wound healing, including steroids, excipients, and most recently quinolones. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Otic antibiotics with and without steroids are commonly administered perioperatively.…”