Prognostic uncertainty in tympanoplasty: how accurately can surgeons predict postoperative air conduction?

OBJECTIVE

To evaluate the accuracy of intraoperative predictions made by otologic surgeons regarding postoperative air conduction (AC) thresholds following middle ear surgery.

METHODS

This retrospective study analyzed clinical data from 103 patients who underwent various middle ear surgeries between January 2024 and May 2025. At the end of each procedure, surgeons estimated the expected postoperative AC threshold based on intraoperative findings. These predictions were compared to actual postoperative audiometric outcomes. The absolute difference between estimated and measured AC thresholds was calculated across standard frequencies and compared. Influencing factors such as pathology, surgical procedure, surgeon experience, and gender were assessed.

RESULTS

Surgeons accurately predicted the direction of hearing change (improvement, stability, or deterioration) in most cases. However, the average absolute deviation between estimated and actual AC thresholds was 11.3 ± 6.7 dB, with the largest discrepancies observed at higher frequencies. Estimation accuracy was significantly better in cases of simple tympanic membrane perforation compared to complex pathologies like cholesteatoma. No significant differences were found between surgical techniques, surgeon gender, or experience level. Surgeons tended to anticipate improved hearing following successful ossicular reconstruction or membrane repair, whereas poorer outcomes were predicted when reconstruction was suboptimal or mass removal disrupted sound conduction.

CONCLUSION

While surgeons can reliably judge the general direction of postoperative hearing outcomes, their ability to predict precise AC thresholds based on intraoperative impressions is limited. These findings underscore the need for realistic preoperative counseling and suggest that future improvements may come from integrating clinical data with machine learning tools to enhance predictive accuracy in otologic surgery.