Pediatric tympanoplasty: A paradigm shift?

Joana A S Marques; Mafalda Sousa; Laurentino Mendes Leal; Jorge Spratley; Margarida Santos

doi:10.1016/j.otorri.2020.10.003

Pediatric tympanoplasty: A paradigm shift?

Acta Otorrinolaringol Esp (Engl Ed). 2021 Jan 13:S0001-6519(20)30197-7. doi: 10.1016/j.otorri.2020.10.003. Online ahead of print.

[Article in English, Spanish]

Authors

Joana A S Marques¹, Mafalda Sousa², Laurentino Mendes Leal², Jorge Spratley³, Margarida Santos⁴

Affiliations

¹ Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Otorhinolaryngology - Department of Surgery and Physiology - Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal. Electronic address: joana.antunesmarques@gmail.com.
² Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Otorhinolaryngology - Department of Surgery and Physiology - Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
³ Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Otorhinolaryngology - Department of Surgery and Physiology - Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal; Health Technologies and Services Research Center (CINTESIS), R. Dr. Plácido da Costa, 4200-450 Porto, Portugal.
⁴ Department of Otorhinolaryngology - Centro Hospitalar Universitário São João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.

PMID: 33454086
DOI: 10.1016/j.otorri.2020.10.003

Abstract

Introduction and objectives: Pediatric tympanoplasty is still a matter of controversy. Many factors have been associated with the surgical outcome of tympanoplasty in children, including age, size and location of the perforation, surgical technique and Eustachian tube dysfunction. The optimal approach and timing of this surgery remains controversial. This study aims to evaluate the outcomes of pediatric tympanoplasty and analyze factors that may influence the success of this surgery.

Materials and methods: A retrospective review was conducted which included children from 5 to 15 years old that underwent tympanoplasty with or without ossiculoplasty for chronic tympanic perforation in a tertiary care university hospital over a 6-year period. Patients were divided in two age groups (5 to ≤10 years old and >10 to 15 years old). Children with cholesteatoma or that underwent simultaneous mastoidectomy were excluded.

Results: 83 cases were included. Average age was 10.7±2.1 years and mean follow-up time was 9 months. Of the cases, 21.7% were revision surgeries. Successful closure of the tympanic membrane perforation was achieved in 76.9% of primary surgeries and 55.6% of revision surgeries. Most of the patients improved their conductive hearing-deficit. No statistical difference in graft failure was noted regarding age, presence of craniofacial dysmorphism and surgical approach. The use of simple graft (temporal muscle fascia or tragus perichondrium) was significantly superior in primary surgery (p<0.05). We also found a significant difference between the location of the perforation and revision surgery, with anterior perforations showing a higher risk (p<0.05).

Conclusions: Pediatric tympanoplasty is effective in repairing chronic tympanic perforations. In our study, accepted predictors of surgical outcome such as age and surgical approach were not associated with graft failure.

Keywords: Child; Niño; Otitis media; Perforación de la membrana timpánica; Suppurative; Supurativo; Timpanoplastia; Tympanic membrane perforation; Tympanoplasty.