Timing of Tympanoplasty in Mucosal Type of Chronic Otitis Media: Does Discharge-free Interval Matter?

Background: Chronic otitis media (COM) is a persistent middle ear infection characterized by tympanic membrane (TM) perforation, often presenting with ear discharge and hearing loss. Tympanoplasty is the definitive treatment, aiming to repair the TM and restore hearing. Conventionally, surgeons prefer to operate on a dry ear to improve outcomes. Objective: The objective of this study was to evaluate whether the discharge-free interval influences the outcome of Type I tympanoplasty in patients with mucosal COM by correlating histopathological changes in the TM remnant with graft uptake and hearing improvement. Materials and Methods: This prospective study included 78 subjects undergoing Type I tympanoplasty. Data on discharge-free interval, pre- and postoperative pure-tone audiometry, and histopathological characteristics of TM margins were collected and analyzed. Results: Graft uptake was successful in 96.2% of cases. Shorter discharge-free intervals (<2 weeks) were associated with increased vascularity (76.9%) and severe diffuse inflammation (33.3%), which corresponded with favorable graft integration. Longer intervals showed predominantly fibrotic (84.6%) and avascular (23.1%) remnants and a slightly higher risk of graft failure. Postoperative hearing improvement was statistically significant across all groups, although hearing gain did not differ significantly between histopathological subtypes. Conclusion: Surgical success in tympanoplasty appears to depend more on surgical technique and effective infection control than on the duration of the discharge-free interval. Tissue vascularity and infection control may play a more critical role, and early surgery in a clinically sterile, well-vascularized ear may be effective without requiring a prolonged discharge-free interval.