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A long term view of myringoplasty in children
J D Blanshard1, A K Robson, I Smith
1Department of Otolaryngology, Bristol Royal Infirmary.
Insights
Type 1 tympanoplasty in children shows good graft success but variable hearing outcomes. Long-term follow-up is crucial for detecting hearing deterioration and complications after this ear surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Tympanoplasty is a common surgical procedure for children with chronic otitis media.
- Long-term outcomes of type 1 tympanoplasty in pediatric patients require further investigation.
Purpose of the Study:
- To evaluate the long-term graft success and audiological outcomes of type 1 tympanoplasty in children under 14.
- To identify factors influencing the success rate and hearing improvement after pediatric tympanoplasty.
Main Methods:
- Retrospective analysis of 59 type 1 tympanoplasties in children under 14.
- Long-term follow-up up to 15 years post-operatively, including audiological assessment.
- Statistical analysis to determine the influence of age, perforation size, surgeon grade, and adenoidectomy.
Main Results:
- 78% of tympanic membranes remained intact, with 6% late graft failure.
- 51% showed audiological improvement, 24% unchanged, and 25% experienced hearing deterioration.
- No significant influence of age, perforation size, surgeon grade, or prior adenoidectomy on outcomes.
Conclusions:
- Type 1 tympanoplasty in children demonstrates high graft success rates but variable hearing gains.
- Late hearing deterioration is a notable complication, emphasizing the need for long-term follow-up.
- Revision procedures had similar graft success but poorer audiological results compared to primary operations.
Abstract:
Fifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiological outcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.