Tympanoplasty in children: A review of 91 cases

Abstract

Objectives: There is a marked diversity in the reported success rates for achieving an intact tympanic membrane following tympanoplasty. Controversy exists about the factors thought to influence surgical outcome. These facts have important implications for the selection of patients who would benefit the most. This study reviews the factors thought to determine the anatomical and functional success of tympanoplasty in children. Materials and methods: Retrospective study of the anatomical and functional results of 91 tympanoplasties performed in children. Age, gender, size and site of perforation, status of operated and contralateral ear, underlying cause of the perforations, surgical technique, preoperative and post-operative hearing levels, post-operative follow-up time and post-operative complications were recorded. We divided our population into two groups according to the expected eustachian tube maturity (younger group (N = 24): 10 years old, older group (N = 67): >10 years old). All patients were evaluated in terms of anatomical and functional outcome and complications. Results: Anatomical success was achieved in 85.7% and functional success was 76.9% after a mean follow-up of 25.6 AE 17.1 months. Anatomical success (intact tympanic membrane) was achieved in 83% of younger vs 87% of older patients ( p = n.s.). Functional (air bone gap closure) success was 75% in the younger group vs 78% in the older group ( p = n.s.). There were no significant differences in post-operative gain at different frequencies (500, 1000, 2000 and 3000 Hz) between the two groups. A previous adenoidectomy in children older than 10 years seems to be an independent predictor of functional success The incidence of minor and major complications were 29% in patients aged 10 and 21% in those older than 10 ( p = n.s.). We report 12.9% minor post-operative complications in successful cases: injury to the chorda tympani nerve (5.7%), wound infection (2.9%), otitis externa (2.9%) and transient vertigo (1.4%). Among the 21 reperforations observed, 92.3% occurred before 1 year. Conclusions: This study shows that tympanoplasty is a valid treatment modality for tympanic membrane perforation in the pediatric population. A tympanic membrane perforation can be closed at any age. There is no age limit below which perforation should not be closed. A previous adenoidectomy in children older than 10 years seems to be an independent predictor of functional success. #

Evaluation of Type I Tympanoplasty in Children in Upper Egypt

“…We did not find any statistically significant difference between patients who had or had not undergone previous adenoidectomy, a result that agrees with those published by most authors [5,9,15]. Ribeiro et al [7] reported that a previous adenoidectomy in patients older than 10 years seem to be an independent predictor of functional success.…”

“…Pignataro et al [9] and Denoyelle et al [16] had reported no significant correlation between age and surgical outcome. Ribeiro et al [7] reported that, a tympanic membrane perforation can be closed at any age and there was no age limit below which perforation should not be closed. Kumar et al [20] in a retrospected study published 2010 reported the results of 132 tympanoplasties performed in children ranging from 6-15 years, no statistical significant difference between age and successful result were found.…”

“…While Blanshard et al [1], Gianoli et al [2] and Mak et al [3] prefer to perform surgery as soon as possible in order to prevent disease progression, ossicular chain erosion, cholesteatoma formation, avoid hearing loss in speech development period and allow swimming activities, Koch et al [4] and Vrabec et al [5] prefer to delay the operation because the high incidence of upper respiratory tract infections during childhood, unpredictable Eustachian tube function, immature immunity and possible spontaneous healing. The success rates of tympanoplasties in children reported in literature vary from 35% to 92% and 94% [6][7][8][9] Problems associated with auditory tube dysfunction and higher incidence of upper respiratory tract infections, may be a reason for poor tympanoplasty results in children than in adults [7]. Age is considered as a key prognostic factor in evaluation of tympanoplasty in children [8].…”

Anatomic and Functional Results of Cartilage Type 1 Tympanoplasty in Children and the Evaluation of the Success of Surgery with Parental Perceptions

“…High success rates have been reported for pediatric tympanoplasty surgeries performed using fascia grafts. Riberio et al (16) found the success rate as 85.7% in their series including 91 pediatric patients, and Uyar et al (11) reported an anatomical success rate of 90.2% in their series with 41 children. Recently, especially for cases with a lower likelihood of success, such as allergy, tubal dysfunction, reperforation, and total perforation, cartilage has been preferred as the graft material.…”

“…The mean age was 13.2±2.7 (8)(9)(10)(11)(12)(13)(14)(15)(16), and the mean follow-up time was 17 (7-36) months. For 25 patients (56.8%), conchal cartilage was used as graft material, and for 19 patients (43.2%), tragal cartilage was used.…”