Postoperative Infection in Myringoplasty: Impact of Surgical Technique and Timing of Infection

Objective: We analyzed ear-related factors contributing to postoperative infections after myringoplasty. We also examined the association between the timing of postoperative infections and graft success. Materials and methods: This retrospective study reviewed clinical data and operative records of patients with chronic tympanic membrane (TM) perforations who underwent myringoplasty. Factors influencing postoperative infection, including surgical techniques, perforation size, external auditory canal (EAC) packing, prophylactic antibiotic type, and the application of topical antibiotic cream, were assessed. In addition, the relationship between the timing of postoperative infection and graft failure was evaluated. Postoperative infection time was categorized as 1, 2, 3, or 4 weeks postoperatively. Results: In total, 263 patients with chronic TM perforations underwent myringoplasty. The overall postoperative infection rate was 12.2% (32/263). The modified over-underlay approach was associated with a postoperative infection rate of 19.0%, in contrast to 11.1% for the conventional over-underlay technique and 8.9% for the underlay technique ( P = .081). No significant differences in postoperative infection rates were identified among the NasoPore packing group (10.9%), the erythromycin cream group (19.4%), and the no-packing group (11.9%) ( P = .418). Similarly, no significant differences were observed between prophylactic antibiotic type (11.2% vs 12.2% vs 25.0%, P = .373) or between the patients with and without topical antibiotic ointment (12.4% vs 10.3%, P = .986). Among the 32 patients with postoperative infections, 21.9% achieved graft success, whereas 78.1% experienced graft failure. Graft success rates were 71.4% (5/7), 9.1% (2/22), and 0.0% (0/3) at 1, 2, and 3 weeks postoperatively, respectively ( P < .01). Conclusions: Our findings suggest that prophylactic antibiotic type, perforation size, the use of topical erythromycin cream, and EAC packing do not significantly influence postoperative infection. However, the surgical technique may affect the risk of postoperative infection. In addition, the timing of postoperative infection may influence graft failure.