Harnessing the Luteal Phase for Better Tympanoplasty Result: Evidence From a Prospective Trial

Objective: This study aimed to investigate the association between serum estrogen levels during different phases of the menstrual cycle and the surgical outcomes of endoscope-assisted tympanoplasty in women with minor central perforations of the pars tensa of the tympanic membrane. Patients and Methods: Eighty female patients with central, small-sized tympanic membrane perforations were enrolled in this randomized clinical trial. Otoscopic examination confirmed the presence of central perforations, and baseline audiometry was conducted before surgery. Serum estrogen levels were measured on the day of tympanoplasty. To assess the impact of hormonal fluctuations, surgeries were scheduled during both the follicular (low estrogen) and luteal (high estrogen) phases of the menstrual cycle. Tympanoplasty was performed under endoscopic guidance, and surgical success was evaluated 3 months postoperatively. Success was defined as complete closure of the perforation with improved hearing thresholds. Results: Patients who underwent tympanoplasty during the luteal phase demonstrated significantly higher graft success rates compared with those operated on during the follicular phase (p < 0.05). Conclusions: Elevated estrogen levels during the luteal phase of the menstrual cycle may positively influence tympanoplasty outcomes, possibly by enhancing wound healing or tissue regeneration. Hormonal status should be considered when planning tympanoplasty in premenopausal women.