MULTIFACTORIAL ANALYSIS OF THE CAUSES OF INEFFECTIVENESS OF CLOSED-TYPE TYMPANOPLASTY

Topicality: Closed-type tympanoplasty is one of the leading methods of reconstructive surgery of the middle ear, aimed at restoring the anatomical integrity of the tympanic membrane and improving sound-conducting function in chronic middle ear diseases. Despite significant progress in the development of otologic methods and the improvement of surgical techniques, the proportion of unsatisfactory outcomes remains relatively high, which makes the study of factors affecting surgical efficacy particularly relevant. Objective: To determine the complex of factors leading to the ineffectiveness of closed-type tympanoplasty in patients with chronic middle ear diseases. Materials and Methods: The study included 41 patients who underwent closed-type tympanoplasty during the period 2020-2024. In 67% of patients, the primary surgery was performed in various clinics of the Republic of Uzbekistan. Revision surgeries and comprehensive examinations were carried out at the multidisciplinary clinic “Bakhtli Hayot” and included clinical-morphological, functional, and systemic analyses of factors influencing the outcomes of surgical treatment. Results: Revision surgeries revealed a complex of morphological changes reflecting a combi-nation of chronic inflammation, impaired ventilation of the middle ear, and secondary tissue remodeling processes. The most frequent pathological finding was cicatricial-adhesive disease, observed in 25 patients (61%). In 61% of patients, diseases of the nasal cavity and paranasal sinuses were identified, including chronic rhinitis and rhinosinusitis, nasal septum deviation, hypertrophy of adenoid tissue, and allergic conditions. These disorders impaired middle ear ventilation and contributed to graft retraction. Conclusion 1. Ineffectiveness of closed-type tympanoplasty is due to a combination of morphological changes, impaired Eustachian tube function, and technical aspects of the surgery. 2. The main factors of unfavorable out-comes are: scarring – 61%, rhinosinus pathology – 61%, cholesteatoma – 37%, recurrent perforation – 29%, and prosthesis instability – 24%. 3. Comprehensive preoperative diagnostics and timely correction of diseases of the nasal cavity and paranasal sinuses improve the effectiveness of reconstructive surgery. Key words: middle ear, chronic diseases, reconstructive surgery, closed-type tympanoplasty, Eustachian tube function, cholesteatoma, scarring, recurrent perforation.

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