Eustachian tube function related to the results of tympanoplasty in children

Abstract

The results of tympanoplastic surgery to repair a perforation of the tympanic membrane are less satisfactory in children than in adults. This paper reports the results of a propspective study of 45 children (51 ears) which was undertaken to determine which, if any, detectable and controllable pre or intraoperative parameters might predict the outcome of tympanoplasty surgery. A "successful" tympanoplasty was defined as that in which the initial graft took, in which the tympanic membrane remained intact, and which was not associated with high negative middle ear pressure, otitis media with effusion, or cholesteatoma during a follow-up period of one to two years. Assessment of hearing related to the tympanoplastic surgery was not included as an outcome measure. With this criteria, the overall success rate of tympanoplasty in children was 35%. The success of tympanoplasty was not related to graft placement, although the laterally placed grafts had a higher take rate (67%) than grafts placed medially (49%). Preoperative measures, such as the assessment of Eustachian tube function using the modified inflation-deflation test and tympanometric evaluation of the contralateral ear, failed to predict the success of tympanoplasty. Tympanoplasty universally failed in the ears in which an acquired cholesteatoma was present. Children remain uncertain candidates for tympanoplasty surgery since, as a group, their Eustachian tube function is not as good as that of adults.

Pediatric Type 1 Cartilage Tympanoplasty: Comparison between Graft Success Rates and Hearing Results in Adults

“…Although tympanoplasty is frequently performed in pediatric patients, there is still no consensus on the necessity and timing of surgery. Factors such as Eustachian tube dysfunction, immature immune system, and frequent upper respiratory tract infections are believed to affect the success of pediatric tympanoplasty, and it has been supposed that tympanoplasty is generally less successful when performed in the pediatric population [1] . Therefore, some authors do not recommend tympanoplasty in children [2,3] .…”

“…The most commonly used graft materials in tympanoplasty is the temporalis muscle fascia, and the success rate is reported to be between 60% and 99% in adults and between 35% and 94% in children [1][2][3][4][5] . Recently, many surgeons prefer cartilage graft for revision cases, subtotal perforations, and risky cases such as atelectasis and retraction due to the high stability of the cartilage and its resistance to negative middle ear pressure.…”

Surgical Outcome in Paediatric Tympanoplasty: Our Experience

“…We used the definition of tympanoplasty type 1 according to Portmann [1]. The success rates of tympanoplasties in children reported in literature vary from 35% [2] to 92% [3,4].…”

Evaluation of Type I Tympanoplasty in Children in Upper Egypt

“…A number of studies have included patients with a variety of middle ear diseases , such as cholesteatoms or ossicular erosions [10] and although most authors judged the rate of success on the basis of anatomical results, Bluestone et al [11] considered the post-operative recurrence of negative middle ear pressure or serous effusion as a surgical failure. Another cause of surgical disparity is the difference of age groups, some authors stared with 2 years old patients [11]. Others started with 8 years old patients [9].…”