The Association of Valsalva Status With Smoking and Its Impact on Ossiculoplasty Outcomes and Complications.

Objectives: To assess the association of a patient's ability to perform a clinically observed Valsalva maneuver with tobacco smoking and post-ossiculoplasty outcomes. Study Design: Case series with chart review. Setting: Tertiary referral, university-based otology practice. Patients: Adult patients (16-88 years of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts, retrograde mastoidectomy with canal wall reconstruction, or mastoid obliteration techniques. Outcome Measures: Patients were classified as Valsalva negative (ValN) or positive (Val+). Comparisons were then made between these two groups for smoking status, final audiometric outcomes, rate of cure of conductive hearing loss, anatomic outcomes, and incidence of significant complications after otologic surgery involving ossiculoplasty. Results: Tobacco smoking is not significantly correlated with the inability to insufflate the middle ear with the Valsalva maneuver (p = 0.557). An insignificant difference in final pure-tone average air-bone gap (PTA-ABG) was observed between the ValN and Val+ groups (20.2 dB HL versus 18.2 dB HL, respectively; p = 0.152). Similarly, the rate of successful PTA-ABG closure to

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