The Effect of Rurality on Severity of Chronic Ear Disease: A Retrospective Chart Review

Introduction: The purpose of this study was to evaluate if rurality affects the severity of chronic ear disease at presentation. A higher percentage of canal wall-down (CWD) mastoidectomy and longer surgical times were used as proxies for increased severity of disease.

Methods: All patients who underwent primary tympanomastoidectomy for cholesteatoma at the University of Kentucky from January 2008 through September 2023 were included in this retrospective chart review. The rurality of the patient’s home county was defined as metro, rural, or very rural as delineated by Rural-Urban Continuity Codes. An unadjusted logistic regression test was used to assess differences in the rate of CWD procedure and an unadjusted linear regression test was used to assess difference in surgical times.

Results: 625 patients met criteria for inclusion. Of these, 34.3% were from metro areas, 26.6% from rural areas, and 39.1% from very rural areas. No statistically significant difference was found in the rate of CWD procedures in rural (p = 0.414) or very rural (p = 0.288) patients compared with metro patients. Additionally, no statistically significant difference was found in surgical time in rural (p = 0.505) or very rural (p = 0.077) patients compared with metro patients. In fact, rural and very rural patients had an average surgical time 3 and 8 minutes shorter than metro patients, respectively.

Conclusions: Patients from the most rural areas in Kentucky (i.e. Appalachia) experienced no significant differences in rates of CWD surgery or length of surgery. Our findings refute the traditional thinking that patients from more socioeconomically and educationally disadvantaged areas present with more advanced chronic ear pathology on initial presentation.