Outcomes of myringoplasty in Australian Aboriginal children and factors associated with success: a prospective case series

Abstract

The objective of this study was to assess the outcomes of myringoplasties in Aboriginal children and to identify factors associated with a successful outcome with the use of prospective case series from primary health care clinics and hospitals in four rural and remote regions of Western Australia. All 58 Aboriginal children, aged 5-15 years, who underwent 78 myringoplasties between 1 January 2000 and 30 June 2001 were included in the study. Complete postoperative (post-op) follow-up was achieved following 78% of myringoplasties. The main outcome measures were (a) success, i.e. an intact tympanic membrane and normal hearing six or more months post-op in the operated ear, (b) closure of the perforation, (c) Post-op hearing improvement. Forty-nine per cent of myringoplasties were successful, 72% resulted in closure or reduction in the size of the perforation and 51% resulted in hearing improvement. After controlling for age, sex, clustering and number of previous myringoplasties, no association was observed between success or hearing improvement and perforation size, or the presence of serous aural discharge at the time of surgery. Myringoplasty resulted in hearing improvement and/or perforation closure in a significant proportion of children. Thus, primary school-aged Aboriginal children in whom conservative management of chronic suppurative otitis media has been unsuccessful should have access to myringoplasty because of the positive impact on their socialization, language and learning that results from improved hearing.

Tympanoplasty for Chronic Tympanic Membrane Perforation in Children

“…Postoperative ABGs were presented in ''bins'' by 11 studies (7,12,14,18,24,29,35,37,39,41,42). Data were available from all these studies around the 20-dB threshold, with 76.7% (n = 408/532) of cases experiencing a postoperative ABG less than 20 dB.…”

Complications of otitis media in Indigenous and non‐Indigenous children

“…In contrast, the rate of perforation among non‐Indigenous children is estimated to be under 2% 25 . Among Indigenous children, the positive benefits of the surgical repair of tympanic membrane perforations (myringoplasty) are well documented and include benefits for children's hearing, socialisation and education 26 …”

Surgery for otitis media among Indigenous Australians

“…We present indirect evidence that the poorer outcomes from myringoplasty performed in outback Australia are unlikely to be related to the inherent nature of the chronic otitis media seen in this setting, as at our institution (the Royal Victorian Eye and Ear Hospital), surgery for chronic otitis media is at least equally successful among patients who acquired their disease in developing countries compared with those from urban Australia (Box). It has been suggested that surgery is less likely to succeed because of the poorer general health status and environmental health conditions experienced by many Indigenous people, 41 and although these factors no doubt affect surgical success, there is some indication that the quality and cultural appropriateness of postoperative follow‐up could be more important determinants of the outcome.…”