Effects of Smoking on Otologic Surgery Outcomes

Objectives/Hypothesis: To determine whether smokers and former smokers have different outcomes of otologic surgery compared to nonsmokers. Smokers have been shown to have worse outcomes in other surgeries, including facial plastics procedures, and it is hypothesized that they will have worse outcomes after ear surgery. Former smokers benefit from reduced risk of heart disease and lung disease after quitting for a period of time. It is also hypothesized that former smokers' risk of ear disease will be reduced over time. Study Design: Retrospective review. Methods: All patients undergoing otologic surgery are included in this study. Smoking status of all patients was determined and patients are classified as nonsmokers, current smokers, and former smokers. Final hearing is determined after a minimum 12 months follow-up. The rates of complications, subsequent surgery, extent of disease, and canal wall status were measured and compared between smokers and nonsmokers, and smokers and former smokers. The former smoker group was further divided into those that quit <5 years and those that quit >5 years. These groups were compared to nonsmokers. Results: A total of 1,531 surgeries were performed on 1,183 patients. Sixty-three percent of the population were nonsmokers, 21% of patients were current smokers, 5% were former smokers, and 11% unknown. Smokers had more cholesteatomas and required more canal wall down surgeries than nonsmokers. Smokers had a significantly higher incidence of ossicular chain involvement with cholesteatoma or discontinuity requiring reconstructions. They required more revision surgeries, and had overall worse final hearing than nonsmokers. Former smokers, regardless of how long they had quit, had significantly more ossicular chain reconstructions than nonsmokers. Former smokers who quit smoking <5 years had results similar to current smokers. Those former smokers who quit >5 years had results similar to nonsmokers. Conclusions: Smokers have significantly worse chronic ear disease than nonsmokers. Surgery in smokers is more extensive and leads to worse hearing outcomes than nonsmokers. Subsequent surgeries are more common in smokers. Former smokers who quit <5 years are similar to current smokers, whereas those who quit >5 years were similar to nonsmokers.