Myringoplasty in Children: Factors Influencing Surgical Outcome

Abstract

Age, size, and site of perforation, condition of the ear, status of the contralateral ear, grafting materials, and more are considered factors influencing the success rates in myringoplasties in children. The ambivalence in results is mainly due to nonhomogeneous patient groups. In an effort to compose groups as homogeneous as possible for analysis of influencing factors, a retrospective study of 51 pediatric myringoplasty cases (51 ears) was undertaken. All patients had perforations caused by simple chronic otitis media. The overall surgical success rate was 82.3% at 18 months, and for young (5 to 10 years) and older (11 to 16 years) children it was 77.2% and 86.2%, respectively. Anterior, central, and total perforations healed without significant differences. Outcome in unilateral perforations was better than bilateral: 96.9% and 55%, respectively (p < 0.01). Discharging ears (100%) healed better compared with dry ears (75%) (p < 0.05). Analysis of the literature also revealed significant difference in success rates of discharging and dry ears: 92.5% and 80.6%, respectively (p < 0.01). We conclude that, contrary to comments in the literature, discharging ears in children favor good outcome and they should be operated on regardless of age and site of perforation. However, in bilateral perforations results may not be so rewarding.

Bilateral Type 1 Tympanoplasty in Chronic Otitis Media

“…Thus, the patients experience only minor or moderate hearing impairment during packing, as documented by the hearing tests. The take rate of 96% is in agreement with international standards of unilateral tympanoplasty type I [8] but not in accordance with three previous studies showing that the presence of bilateral perforations adversely influence the success rate [9][10][11]. No adverse influence was noted in the two previous studies on bilateral surgery, in which the take rate was 91% in the study by Mitchell et al [4] of fat myringoplasty and 85% in the study of Katsura et al [5] of 17 patients operated by underlay techniques.…”

Evaluation of Type I Tympanoplasty in Children in Upper Egypt

“…Of those with taken graft 64 out of 66 has perfect graft at follow-up. These results are in line with data reported in the literature [4,[14][15][16]. Two cases of 66 successful case (approximately 3%) experienced secondary complications in the form of blunting of the anterior angle and tympanic membrane retraction.…”

“…The site of perforation did not statistically affect the outcome in our series as has been previously reported by others [4,9,15,16]. They suggested that, surgical outcome of pediatric tympanoplasty was not affected by the site or the size of perforation.…”

“…Denoyelle et al [16] found that inflammatory changes within the middle ear mucosa independently influenced the risk of an abnormal post-operative tympanic membrane and suggested that such cases should be treated using more resistant graft material such as autologaus cartilage. On the other hand, in a series of 51 pediatric myringoplasty cases Caylon et al [15] found that the success rate in dry ears was lower than in discharging ears and assumed that it may be due to a possible decrease in the vascularity of middle ear mucosa. Our results are concordant with data reported in the literature [18].…”

A Comparative Study of Temporalis Fascia Graft and Vein Graft in Myringoplasty

“…Pediatric age group was kept out of this study because this age group is still considered to have high failure rate because of possibilities of eustachian tube dysfunction, middle ear effusion and patient management problems [9][10][11]. Elderly population was excluded from the study because of many associated medical problems like diabetes mellitus, hypertension, presbyacusis and sensory neural hearing loss.…”