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Objectives: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6–24 months after surgery.

Design: A retrospective cohort study of prospectively collected data. Setting: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013–2019.

Participants: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit.

Main Outcome Measures: The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery.

Results: In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs.

Conclusion: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery.