\s=b\The long-term results of myringoplasty in children, including closure of perforation and hearing improvement, were reviewed in relation to age, condition of the operated-on ear, and condition of the untreated ear. The overall success rate in 155 operations evaluated one year postoperatively was 79%. Children in the 5-to 8-year-old age group had a success rate comparable to that of older (9-to 12-year-old) children (77.7% vs 80.4%). Where graft failure occurred, it was usually within one year of surgery. The outcome of surgery could not be related to the presence or absence of chronic otitis media in the untreated ear, the status of the operated-on ear (whether dry or discharging), or the performance of adenoidectomy before myringoplasty. Results of postoperative hearing, analyzed by calculating the postoperative air-bone gap and by speech audiometry, were similar in the two age groups. It is concluded that myringoplasty has a good chance of success in children, regardless of age.The surgical management of chron¬ ic suppurative otitis media in children remains a controversial sub¬ ject. Most otologie surgeons believe that the results of tympanoplastic surgery to repair a tympanic mem¬ brane perforation are less satisfacto¬ ry in children than in adults, attribut¬ ing their findings both to the higher incidence of upper respiratory tract infections in children leading to acute otitis media or otitis media with effu¬ sion (OME), and to the unpredictabili¬ ty of their eustachian tube function.1The optimum age for myringoplasty is considered to be anywhere from 3 years to puberty.2"6 While for some children, closure of the tympanic membrane appears to be contraindi¬ cated, for others it is a necessity because of hearing problems and recurrent infection. This retrospective study of myrin¬ goplasty in children was undertaken to determine whether surgery in chil¬ dren aged 5 to 8 years is less success¬ ful in terms of perforation closure and hearing gain than in older children, and to identify which, if any, preoper¬ ative parameter might predict the outcome of surgery.
PATIENTS AND METHODSThe charts of 172 children, aged 5 to 12 years, who underwent myringoplasty between 1974 and 1985 in Kaplan Hospital (Rehovot, Israel) were reviewed. All the children had a central perforation involv¬ ing only the pars tensa of the tympanic membrane, without cholesteatoma. All children aged 5 years or older who were seen in our clinic and in whom perforation did not close spontaneously for at least one year of follow-up underwent surgery. No further preselection of surgical candidates was made. Data were available from 155 children undergoing 172 operations, in¬ cluding 17 revision procedures.In all patients, the postauricular approach was used and temporal fascia was used as graft material. The underlay technique was used in 96% of patients and the overlay method (lateral graft place¬ ment) in the rest. The patients were rou¬ tinely discharged on the morning following surgery. Prophylactic antibiotics were not given before or aft...
