Tympanoplasty in children

Abstract

Closure of uncomplicated tympanic membrane perforation (tympanoplasty) is usually a straightforward procedure with a good success rate. Many studies report a success rate from 60 to 99% in adults, whereas a 35-94% success rate in children. The definition of successful tympanoplasty varies from one author to other. Some authors report that an intact tympanic membrane considered a successful surgical result, whereas the other authors may also consider the postoperative hearing, as well as middle ear aeration, as a part of good outcome. This review is an insight into the recent and as well as the past literature on prognostic factors in pediatric tympanoplasty. This article reports an overview of the commonly reported factors which are thought to affect the tympanoplasty in children. Age is considered as one of the most important factor determining the successful outcome of tympanoplasty. Most of the studies did not reveal any significant difference in result between pediatric tympanoplasty from those of adult ones. Interestingly, in one study; it was found that patients younger than 16 years had decreased graft uptake compared with adults. However, in this same study; it was found that the younger patients had better postoperative hearing with better postoperative AB gap closure. The other factors which seem to influence the success rate of tympanoplasty are the size of perforation, technique used, presence or absence of otorrhoea, eustachian tube function and status of the contralateral ear. A study has revealed that posterior perforation had poorer results but it may be a distorted finding as the surgical method was not controlled. Regarding the size of perforation and its influence on the success rate of tympanoplasty, there is again difference of opinion. In one study, it was found that perforations greater than 50% had poorer results, but other studies contradict this statement stating that the success of tympanoplasty has no bearing with the size of perforation. Poor eustachian tube function has been offered as an explanation by some authors as younger age may be correlated with lower tympanoplasty success rates, but some authors refute this by stating that poor eustachian tube function not necessarily an indicator of poor surgical outcome. In conclusion, the success of tympanoplasty in children, with little doubt, depends on a number of factors. The past and recent literature has not produced a consensus of convincing evidence supporting any one parameter.

Long-term follow-up of chronic suppurative otitis media in a high-risk children cohort

“…Age has previously been seen as one of the most important factors determining successful outcome for surgical management of CSOM, but a number of recent studies contradict this [27,28]. However, in settings where the surgical capacity is limited, the possibility of spontaneous healing should be considered when selecting young children for surgery.…”

Epidemiology and Pathogenesis of Otitis Media: Construction of a Phenotype Landscape

“…COME is reduced by adenoidectomy [van den Aardweg et al, 2010], oral steroids [Simpson et al, 2011] or ventilation tube (grommet) surgery [Browning et al, 2010], although effects may be short-lived. For CSOM, antibiotics may reduce otorrhoea [Macfadyen et al, 2006], as may tympanoplasty [Sarkar et al, 2009]. Figure 6 summarises factors known or hypothesised to have an impact on susceptibility to OM.…”

A comparison of two myringoplasty techniques in Nepalese children: A prospective randomized trial

“…Presently, temporalis muscle fascia is the most frequently used grafting material for the repair of tympanic membrane perforation in children and recent studies have reported graft success rate of 70-91% [8,9,11,12,16,30], which is comparable to success rate of 60-99% [17,18] in adults. The problems with the use of fascia as a graft material are due to atrophy or shrinkage of graft or its nonvascularization leading to failure [19].…”