Pediatric myringoplasty: definition of "success" and factors affecting outcome

Recent studies have reported a high success rate of pediatric myringoplasty, but their definition of success and length of follow-up vary widely. Authors debate whether the success of a pediatric myringoplasty should be defined purely by an intact tympanic membrane or should analysis of middle ear health and audiometric data also be included. For the purposes of this study, success was defined as an intact tympanic membrane at 12 months postsurgery without evidence of effusion and preservation of hearing.

To determine the true success rate of myringoplasty and identify any independent factors that significantly influence outcome.

This was a retrospective analysis of 132 myringoplasties performed at Birmingham Children's Hospital. Cases were grouped into those children aged younger than 8 years and those aged 8 years and older.

An intact tympanic membrane was present in 80.0% of cases at the first postoperative visit. However, at 12 months, the previously defined success rate, cases decreased to 67.3%. Younger age (p < 0.0047) and anterior perforations (p <0.0038) were the only factors found to be associated with a poorer outcome.

The true rate of success of a pediatric myringoplasty would seem to be lower than rates commonly quoted to parents, and this finding is in keeping with other otologists using a similar definition of success. Younger age at the time of surgery and anterior perforations have a less successful outcome. These findings are important when counseling/consenting carers of younger children about to undergo a myringoplasty.