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Published on: January 19, 2022
Tympanoplasty in children
Saurav Sarkar1, A Roychoudhury, B K Roychaudhuri
1Department of ENT and Head and Neck Surgery, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, India. kushalkushal79@rediffmail.com
Insights
The success of pediatric tympanoplasty depends on multiple factors, including age and perforation size, but there is no consensus on their definitive impact. Further research is needed to establish clear prognostic indicators for successful outcomes in children undergoing tympanoplasty.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Outcomes Research
Background:
- Tympanoplasty, the surgical repair of tympanic membrane perforations, has variable success rates in children (35-94%).
- Defining successful tympanoplasty outcomes, whether solely by membrane closure or including hearing and aeration, remains inconsistent across studies.
Purpose of the Study:
- To review and analyze prognostic factors influencing the success of tympanoplasty in pediatric patients.
- To synthesize current literature on factors affecting surgical outcomes in pediatric tympanoplasty.
Main Methods:
- Comprehensive literature review of past and recent studies on pediatric tympanoplasty.
- Analysis of reported prognostic factors such as patient age, perforation size, surgical technique, and eustachian tube function.
Main Results:
- Age is a significant factor, with some studies showing decreased graft uptake but improved hearing in younger children (<16 years) compared to adults.
- Perforation size, presence of otorrhoea, eustachian tube function, and contralateral ear status are also implicated, though findings are often contradictory.
- Contradictory evidence exists regarding the impact of perforation size and eustachian tube function on surgical success.
Conclusions:
- The success of pediatric tympanoplasty is multifactorial, with no single parameter consistently predicting outcomes.
- Current literature lacks consensus on definitive prognostic factors, highlighting the need for further research to establish reliable indicators for successful pediatric tympanoplasty.
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.
