The effect of surgeon experience on tympanic membrane closure

OBJECTIVE: Review of the English language literature finds little documentation of the relation of otology or otolaryngology outcomes to a surgeon's age, years in practice, or numbers of cases previously performed. Because of one surgeon's adoption of a new tympanoplasty technique for uncomplicated tympanic membrane perforations, our institution was situated to report an example of a surgical learning curve with its outcome. Experience versus outcome is worth establishing objectively because these relationships reflect on training and certification. DESIGN: This retrospective review of the medical records tallied preoperative risk factors and perforation sizes for four consecutive 100‐blocks of double‐layer tympanoplasties. SETTING: An otology specialty care facility in Addis Ababa, Ethiopia. PARTICIPANTS: Participants were 359 patients with tympanic membrane perforations without ossicular discontinuity or erosion who underwent 400 primary simple tympanoplasties. INTERVENTION: A double‐layer tympanoplasty was performed in each operation using an endaural approach. OUTCOME MEASURES: The outcomes were closure of the perforation and change in hearing. RESULTS: There were no statistically significant differences between the four 100‐block case cohorts in preoperative risk factors and perforation sizes. Preoperative, postoperative, and change of hearing were also the same between the four groups; and statistically there was no significant difference between the four 100‐block cohorts. Perforation closure for each successive 100‐block increased from 74% to 98%. The closure rates of the second, third, and fourth 100‐block were each statistically significantly different from the first 100‐block, but not from each other. CONCLUSION: This simple study demonstrates the surgical learning curve with increased surgeon experience, and is one of very few such documentations. With each additional 100 cases, the outcomes improved, and sheds light on the numbers of cases necessary for competency. LEVEL OF EVIDENCE: 3