# Does internal critical examination lead to improved quality of clinical practice? A retrospective follow-up analysis concerning the success rates of Myringoplasty

## TL;DR

This study found that self-assessing surgical outcomes led to better practices and improved success rates in myringoplasty procedures.

## Contribution

The study demonstrates that internal critical examination of surgical outcomes can lead to measurable improvements in clinical practice and patient success rates.

## Key findings

- The overall success rate of myringoplasty increased from 74.9% in 2019 to 88.4% in 2021.
- Use of silastic sheets decreased significantly from 80 cases in 2019 to 13 cases in 2024.
- Postoperative air conduction gain was significantly higher in successful anatomical closures.

## Abstract

The aim of this study was to assess whether recommendations from a retrospective study conducted in 2019 translated into measurable changes in clinical practice and patient outcomes.

In this retrospective follow-up cohort study, patients who underwent a myringoplasty between January 2020 and December 2021 at the Jeroen Bosch Hospital in The Netherlands were analyzed. The same methodology was applied and the same patient, surgical, and follow-up data were collected as in our previous study in 2019. Recommendations in 2019 included a minimum of 15 procedures per surgeon per year, application of cartilage grafts, and reduction of silastic sheets use. The primary outcome was to assess the adherence to the 2019 recommendations. Secondary outcome was the change in the success rate of the myringoplasty, and tertiary outcome was the auditory performance after surgery.

172 patients were analyzed. While recommended in 2019, the required number of 15 procedures per year was not always reached. Additionally, use of temporalis fascia was reduced from 80 cases in 2019 to 4 in 2024. The use of silastic sheets was reduced from 80 cases in 2019 to 13 cases in 2024. The overall success rate of closure of the perforation was 88.4% compared to 74.9% in 2019. Postoperative audiometry showed significant air conduction gain in successful anatomical closure compared to unsuccessful closure (9.06 ± 8.48 dB vs. 4.14 ± 6.96 dB).

Internal self-assessment of surgical outcomes is associated with changes in surgical behavior and subsequently increased closure success rates.