Impact of Preoperative Ear Moisture on Surgical Outcomes of Endoscopic Ossicular Chain Reconstruction

Objective To evaluate the impact of ear moisture status on surgical outcomes following endoscopic ossicular chain reconstruction in patients with chronic otitis media. Methods A retrospective analysis was performed on 148 patients (148 ears) who underwent endoscopic ossicular chain reconstruction between January 2021 and December 2023. Patients were divided into a dry ear group (n=74) and a wet ear group (n=74) based on ear moisture status. Baseline characteristics, preoperative fungal and bacterial detection rates, as well as postoperative improvements in low-frequency air conduction (LFAC), air-bone gap (ABG), and tympanic membrane graft healing rates at 6 months were compared between the two groups. Results Baseline characteristics were comparable between groups (P>0.05). The wet ear group had significantly higher preoperative fungal and bacterial positive rates (P=0.006, P=0.015). Postoperative infection rates showed no statistical difference between dry ear group (6.76%) and wet ear group (9.46%, P=0.765). Both groups achieved significant improvements in LFAC and ABG after surgery (P<0.001), with similar hearing improvement magnitude. Tympanic membrane graft success rates were also comparable (97.3% vs 90.5%, P=0.166). Preoperative fungal positivity was associated with elevated postoperative infection risk (25.00% vs 7.95%, P=0.004), whereas preoperative bacterial detection showed no significant correlation with postoperative infection (P=0.578). Conclusion Endoscopic ossicular chain reconstruction significantly improves hearing outcomes in patients with chronic suppurative otitis media (CSOM). Although wet ear status leads to higher preoperative bacterial and fungal detection rates, it does not adversely affect postoperative hearing improvement or tympanic membrane healing. Preoperative fungal culture positivity was correlated with elevated postoperative infection risk. Surgical efficacy is not influenced by ear moisture status, and it is unnecessary to insist on a dry ear status preoperatively. Instead, fungal infection prevention and control should be prioritized in wet ear patients.