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Tympanoplasty type I in children--an evaluative study
Gautam Bir Singh1, T S Sidhu, Arun Sharma
1Department of ENT and HNS, Institute of Medical Sciences and S.S Hospital, BHU, Varanasi, India. gbsnit@yahoo.co.in
Insights
This study found that age does not significantly impact tympanoplasty type I success rates in children. Anterior perforations, however, show higher failure rates, requiring careful surgical consideration for successful outcomes.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Outcomes
Background:
- Paediatric tympanoplasty type I success rates and influencing factors remain debated.
- Conflicting views exist regarding optimal surgical timing and patient-specific variables.
Purpose of the Study:
- To prospectively evaluate the success rate of paediatric tympanoplasty type I.
- To analyze factors influencing the outcome of tympanoplasty type I in children.
Main Methods:
- A cohort study compared 20 paediatric patients (8-14 years) with 20 adult patients undergoing tympanoplasty type I.
- Graft uptake at 6 months and audiological success (≥10 dB hearing improvement) were primary outcome measures.
- Statistical analysis utilized the chi-squared test with Yates correction.
Main Results:
- Paediatric tympanoplasty type I achieved an 80% graft uptake and 61% hearing improvement.
- Success rates in children were comparable to adults (85% graft uptake, 65% hearing improvement).
- Age, Eustachian tube function, contralateral ear status, and perforation site/type did not significantly influence outcomes, except for anterior perforations showing poorer results.
Conclusions:
- Tympanoplasty type I can be performed in children without necessarily delaying surgery based on age.
- Factors like Eustachian tube function and perforation characteristics generally do not affect surgical success.
- Anteriorly placed perforations warrant increased vigilance due to a higher failure rate.
Objective:
A considerable controversy surrounds the subject of paediatric tympanoplasty type I. Conflicting views regarding timing of surgery and various other factors like Eustachian tube, status of contralateral ear, site and type of perforation etc. are presented by various published case series in medical literature. However, very few prospective studies address the issue. Thus, a prospective study was planned to evaluate the success rate of paediatric tympanoplasty type I and analyse the factors suggested to influence the outcome of the said surgery.
Method:
A cohort study with control was carried out in 40 patients of chronic suppurative otitis media-mucosal disease in a tertiary care teaching hospital. Patients were divided into two groups of 20 cases each, one comprising of paediatric patients (8-14 years) and other comprising of adult patients (more than 14 years of age). All the patients underwent tympanoplasty type I by post auricular inlay technique. An intact graft at the end of 6th month was considered a success and a minimum hearing improvement of 10 db in two consecutive frequencies was regarded as an audiological success. Results were tabulated and statistically analysed using chi2-test (with Yates correction).
Results:
A success rate of 80% in terms of graft uptake and hearing improvement of 61% was seen in paediatric cases, compared to 85% graft uptake and 65% hearing improvement in adult cases. Statistically, on applying chi2-test, the value of P is >0.05 which is insignificant was obtained, indicating that age does not influence paediatric tympanoplasty type I. Also, the data for evaluating the correlation between Eustachian tube and paediatric tympanoplasty type I showed no statistical significance. In addition, no association between site and type of perforation and paediatric tympanoplasty type I was observed when results were compared to adult patients. However, anteriorly placed perforations were found to give poor results in both adult and paediatric group.
Conclusions:
The results of this cohort study mitigates against delaying tympanoplasty type I in paediatric population. This study also elucidates that Eustachian tube, contralateral ear pathology, site and type of perforation do not influence the outcome of the said surgery. However, anteriorly placed perforations require vigilance while repair in view of high failure rate. We recommend the age of 8 years for the paediatric tympanoplasty type I, but in view of redundancy of eustachian tube factor, the criteria for delineating minimum age for success of the said surgery is open to debate. More prospective studies are required in this direction.
