Development and Validation of a Clinical Score for Predicting the Risk of Tympanosclerosis Before Surgery

• Published in: Ear, nose, & throat journal Vol. 101; no. 4; pp. NP169 - NP177
• Main Authors: Dong, Zhihuai, Zhou, Mingguang, Ye, Gaofei, Ye, Jing, Xiao, Mang
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.05.2022; SAGE PUBLICATIONS, INC
• Subjects: Calcification; Ear diseases; Eardrum; Maxillofacial surgery; Otolaryngology; Surgery; clinical score; frequency-specific air-bone gap; tympanosclerosis; tympanum calcification pearl
• ISSN: 0145-5613; 1942-7522
• DOI: 10.1177/0145561320951676

Objective: To develop and validate a clinical score to predict the risk of tympanosclerosis before surgery. Methods: A sample of 404 patients who underwent middle ear microsurgery for otitis media was enrolled. These patients were randomly divided into 2 cohorts: the training cohort (n = 243, 60%) and the validation cohort (n = 161, 40%). The preoperative predictors of tympanosclerosis were determined by multivariate logistic regression analysis and implemented using a clinical score tool. The predictive accuracy and discriminative ability of the clinical score were determined by the area under the curve (AUC) and the calibration curve. Results: The multivariate analysis in the training cohort (n = 243, 60%) identified independent factors for tympanosclerosis as the female sex (odds ratio [OR]: 3.83; 95% CI: 1.66-9.37), the frequency-specific air-bone gap at 250 Hz ≥ 45 dB HL (OR: 3.68; 95% CI: 1.68-8.57), aditus ad antrum blockage (OR: 3.29; 95% CI: 1.38-8.43), type I eardrum calcification (OR: 25.37; 95% CI: 8.41-88.91) or type II eardrum calcification (OR: 18.86; 95% CI: 6.89-58.77), and a history of otitis media ≥ 10 years (OR: 4.10; 95% CI: 1.58-11.83), which were all included in the clinical score tool. The AUC of the clinical score for predicting tympanosclerosis was 0.89 (95% CI: 0.85-0.93) in the training cohort and 0.89 (95% CI: 0.84-0.95) in the validation cohort. The calibration curve also showed good agreement between the predicted and observed probability. Conclusions: The clinical score achieved an optimal prediction of tympanosclerosis before surgery. The presence of calcification pearls on the promontorium tympani is a strong predictor of tympanosclerosis with stapes fixation.