Tympanoplasty in children

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.     

Tympanoplasty in children

In this, study, an attempt has been made to find out if the age of the child is a factor in influencing the surgical outcome of tympanoplasty. The study group comprises 52 children, divided into two subgroups; 8-11 years and 12-15 years. The success is defined as an intact tympanic membrane after 6 months of surgery. The success rate is slightly higher in 12-15 year age group (90.24%) than in 8-11 year age group (81.8%). The overall success rate in 86.54% in this series.     

Tympanoplasty in children. The Boston Children's Hospital experience

Considerable controversy surrounds the subject of tympanoplasty in children. Conflicting opinions about the indications, patient selection, timing, and technique of surgery are supported by various published series of cases. The records of 64 consecutive tympanoplasty procedures performed at the Boston (Mass) Children's Hospital over a recent 6-year period were reviewed. The study was limited to cases of repair of uncomplicated perforation of pars tensa that did not require ossiculoplasty or mastoidectomy. Surgery was successful in 73% of cases. A number of factors that are postulated to affect the outcome of surgery have been analyzed to assess their utility in selecting successful surgical candidates. Only patient age at the time of surgery was found to have statistical significance. We conclude that tympanoplasty for repair of perforation is warranted for children 8 years of age and older.     

Tympanoplasty in children and anatomical variations of the epipharynx

Short-term results or post-operative check-ups after tympanoplasties in children and adults are compared. There is no higher incidence of recurrent perforations in children. The distribution of air cells in adults and children does not vary, indicating that anatomic variations, rather than disease, are responsible for the sclerosis in the mastoid. Anatomic variations of the epipharynx might influence ventilation. Correlations between the width of the epipharynx and the distance between molars and premolars are shown, as is an inverse relation between the height of the palate and the height of the septum. These observations might be important for a prognosis in patients with ear disease.     

Tympanoplasty in children: A review of 91 cases

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, pre-operative 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 ± 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.     

Tympanoplasty in children. An analysis of late results

The late results of tympanoplasty were analyzed three to fifteen years postoperatively in 124 ears of children aged 2 to 14 years with noncholesteatomatous chronic otitis. The primary graft take rate was 92% and only 4% of the ears had perforations at follow-up. The hearing results were very good. The overall results are similar in children operated on at the ages of two to seven years and in children operated on at the ages of 8 to 14 years. We recommend tympanoplasty in children of all ages, including preschool age.     

Tympanoplasty

The study comprises of 164 ears of modified radical mastoidectomy with tympanoplasty performed as one stage operation in our hospital. The ears were followed up for 5 years. Out of these 164 ears, postaural approach was performed in 90 ears and endaural with removal of bone from inside out in 74 ears. Tympanoplasty was performed in all the cases as one stage operation with incus transposition in 42 cases, autogenous cortical bone columella between malleus handle and stapes head in 80 cases, between stapes footplate and graft material in 30 cases and preserved homograft ossicles between stapes footplate and graft in 12 cases. Dry ears with graft take up occurred in 92% cases within 6 to 10 weeks. No recurrence of cholesteatoma was seen. Ossiculoplasty using autogenous cortical bone columellas resulted in somewhat greater improvement in the post operative airbone gap than ossiculoplasty with auto or homograft ossicles. Similarly the post operative gap improved more with an intact stapes superstructure than in ears where the stapes superstructure was absent. The use of a cortical bone can be recommended in cases where the patient’s own ossicles are affected by disease and cannot be used.     

Tympanoplasty

We review many aspects of tympanoplasty, including physiologic principles and our philosophy regarding the treatment of chronic otitis media. We then describe the various techniques of tympanoplasty that we currently use and indications for each technique. Hearing results after 388 tympanoplasty procedures in which the middle ear was judged as being aerated postoperatively are presented. The best hearing results occurred after type I tympanoplasty. An intact stapes was a positive prognostic indicator when the ossicular chain had to be reconstructed. There were no differences in hearing outcomes between canal wall-up and canal wall-down procedures.     

Tympanoplasty in pediatric patients

OBJECTIVE: The aim of this study is to analyze the clinical features and follow-up of a series of pediatric patients with chronic otitis media undergoing tymponaplasty surgery and to identify the effect of the factors on the course. METHODS: Forty-one children (mean age 15.1+/-2.62 years, range from 8 to 16 years) who had undergone tympanoplasty with or without ossicular reconstruction were evaluated. Age, gender, size and site of perforation, status of operated ear (dry/discharging), status of the contralateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels, average postoperative follow-up time, and postoperative complications were recorded. RESULTS: Myringoplasty in 28 patients (68.3%), incus interposition in 7 patients (17.1%), partial ossicular replacement prostheses in 4 patients (9.7%) and total ossicular replacement prostheses in 2 patients (4.9%) were performed. In the 37 (90.2%) of patients, intact graft was determined during postoperative follow-up. Surgical success including intact graft and postoperative air-bone gap of less than 25 dB were obtained in 34 (82.9%) cases. CONCLUSIONS: The present study suggested that tympanoplasty was a quite successful method in the appropriate pediatric patients between the ages of 8 and 16 years. In the preoperative evaluation for surgery success, some factors, such as dry middle ear, healthy contralateral ear and concordant to postoperative care should be considered.