A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis

Abstract

Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake (p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.

Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study

“…Although t emporalis fascia is easily accessible and reliable as a graft material, the peculiarities of the oncologic middle ear supported the surgeon's choice of adding an extra layer of support with cartilage for most of the oncologic cases with a TMP ≥ 20% which is more restrictive than in the 50% reported in the literature ( 40 ). One exception was patient #1 for whom no cartilage was used for extra resistance.…”

Endoscopic Fascia-Cartilage Composite Grafting in Chronic Suppurative Otitis Media

“…10 However, this advantage is negated regarding healed tympanic membrane strength and hearing rehabilitation in air-bone gap closure. 11 Cartilage as an alternative to fascia was first introduced in the forms of palisades. These cartilage palisades as a graft material increase the strength of the tympanic membrane but have more nutritional requirements.…”