The Impact of Tympanoplasty on Tinnitus Improvement in Patients With Chronic Otitis Media: A Systematic Review and Meta-Analysis

Objective: To investigate the changes in tinnitus among patients with chronic otitis media (COM) before and after tympanoplasty.Methods: A literature search was conducted using the PubMed, EMBASE, and Web of Science electronic databases. Patients with COM alone and preoperative tinnitus who underwent tympanoplasty (with or without ossiculoplasty) and had their tinnitus outcomes evaluated using the Tinnitus Handicap Inventory (THI), the Visual Analogue Scale (VAS), or self-reported symptom changes were included. Patients with concurrent cholesteatoma or those who underwent mastoidectomy were excluded. Meta-analyses of THI scores and self-reported symptom changes were performed using the random-effects model.Results: Out of the 134 articles identified, 9 studies with 483 patients were included. Ossiculoplasty was performed when necessary in 3 studies. The THI was used in 5 studies, with mean changes in scores ranging from -24.00 to +1.40. Three studies were included in the meta-analysis, which showed a mean difference of -3.93 (95% confidence interval (CI): -8.61 to 0.76; P = .10). The VAS was used in 3 studies, with mean changes in scores ranging from -3.35 to -0.10. Self-reported symptom changes were recorded in 4 studies, involving 231 patients. After surgery, tinnitus disappeared in 77 (33.33%) patients, was alleviated in 96 (41.56%) patients, remained unchanged in 45 (19.48%) patients, and deteriorated in 13 (5.63%) patients. In the meta-analysis, the weighted proportions were 42.63% (95% CI: 20.43%-66.52%), 41.17% (95% CI: 27.26%-55.85%), 13.28% (95% CI: 4.36%-26.06%), and 3.86% (95% CI: 0.70%-9.41%), respectively.Conclusion: Although the majority of patients with COM and concurrent tinnitus experienced a reduction in tinnitus severity following tympanoplasty, the meta-analysis did not demonstrate a significant improvement in THI scores. Further multicenter prospective studies are needed to identify the prognostic factors, given the high heterogeneity in patient characteristics and operative methods across the current studies.