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Anterior tab flap versus standard underlay myringoplasty in children
Riccardo D'Eredità1, Marko B Lens
1Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Vicenza Civil Hospital, Vicenza, Italy. riccardo.deredita@ulssvicenza.it
Insights
The anterior tab flap (ATF) myringoplasty is a safe and effective technique for tympanic membrane (TM) perforation closure in children. However, it did not show a statistically significant improvement over standard underlay myringoplasty in this study.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Innovation
Background:
- Tympanic membrane (TM) perforation closure in children, particularly anterior or total perforations, poses challenges due to graft support limitations.
- The anterior tab flap (ATF) myringoplasty technique was proposed to enhance graft stability by incorporating an anterior tab under the TM annulus.
Purpose of the Study:
- To prospectively compare the efficacy of ATF myringoplasty versus standard underlay (SU) myringoplasty for TM perforation closure in pediatric patients.
- To evaluate graft healing, anterior blunting, and TM retraction rates following both surgical techniques.
Main Methods:
- A prospective, randomized controlled study involving 59 children undergoing ATF myringoplasty and 52 undergoing SU myringoplasty.
- All surgeries were performed under general anesthesia, with a primary outcome of TM healing and secondary outcomes of anterior blunting and TM retraction.
- A two-year follow-up period was maintained for all participants.
Main Results:
- At two years, 93.2% of TM perforations closed with ATF myringoplasty compared to 84.6% with SU myringoplasty, though this difference was not statistically significant (OR = 0.4).
- Stable TM closure was observed in 55 children in the ATF group and 44 in the SU group.
- No instances of anterior blunting or TM retraction were reported in either group.
Conclusions:
- ATF myringoplasty is a safe and effective surgical option for closing tympanic membrane perforations in children.
- The study did not find ATF myringoplasty to be associated with a statistically significant reduction in residual perforations compared to SU myringoplasty.
- Further investigation with a larger patient cohort is recommended to definitively assess the comparative effectiveness of ATF myringoplasty.
Objectives:
Tympanic membrane (TM) perforation closure can present a problem in children, especially in anterior and total perforations, because of the anterior's lack of support for the graft. It was suggested that the anterior tab flap (ATF) myringoplasty, an underlay graft with an anterior tab under the TM annulus, could provide better stability of the graft. We undertook a prospective, randomized, controlled study to compare the ATF myringoplasty with the standard underlay (SU) myringoplasty in children.
Methods:
We randomly assigned 59 children to undergo ATF myringoplasty and 52 to undergo SU myringoplasty at a tertiary care pediatric institution. Surgery was performed under general anesthesia in all patients. The primary outcome was the healing of the TM; the secondary outcomes were anterior blunting of the graft and presence of retraction of the TM. Two years of follow-up were obtained in all enrolled children.
Results:
At 2 years of follow-up, there were 55 stable TM closures in the ATF arm and 44 in the SU arm. Although the TM closure was higher in the ATF arm than in the SU arm (93.2 and 84.6%, respectively), the results were not statistically significant (odds ratio = 0.4, 95% confidence interval = 0.12-1.41). Anterior blunting and TM retraction were not encountered.
Conclusion:
The ATF myringoplasty is a safe and effective method for TM closure in children. However, compared with the SU myringoplasty, the ATF myringoplasty is not associated with an overall decrease in the incidence of the residual perforations. Further assessment in a larger study is proposed.
