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Results of myringoplasty in children with cleft palate: a patient-matched study
Emilie Harterink1, Nicolas Leboulanger, Salma Kotti
1*Otolaryngology/Head and Neck Surgery department, Armand-Trousseau Children Hospital, Paris, France; †University Medical Center Utrecht, The Netherlands; and ‡Unité de Recherche Clinique de l'Est Parisien, AP-HP, Hôpital Saint Antoine, Paris, France.
Insights
Cartilage myringoplasty successfully closes tympanic membranes in children with cleft palate. However, hearing outcomes are worse compared to controls, indicating a need for further functional improvement strategies.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Cleft palate is associated with otologic complications, including tympanic membrane perforations.
- Myringoplasty aims to repair these perforations and restore middle ear function.
- Cartilage myringoplasty is a common technique for tympanic membrane reconstruction.
Purpose of the Study:
- To evaluate the anatomic and functional results of underlay cartilage myringoplasty in children with cleft palate.
- To compare outcomes with a matched control group of patients without cleft palate.
- To analyze outcomes at different postoperative time points.
Main Methods:
- A case-control study was conducted using an otologic database.
- Children with cleft palate and perforated tympanic membranes were matched with controls based on age, perforation size, and ear status.
- Surgical data, postoperative outcomes (anatomic and functional), and reinterventions were reviewed.
Main Results:
- Anatomic success rates were similar (84%) in both cleft palate (32 patients) and control (32 patients) groups.
- Functional outcomes, including air conduction and air-bone gap, were significantly worse in the cleft palate group.
- Functional success was lower in the cleft group (58%) compared to the control group (87%).
Conclusions:
- Underlay cartilage myringoplasty is effective in achieving tympanic membrane closure in children with cleft palate.
- Despite successful closure, functional hearing outcomes remain suboptimal in this population.
- Further research is needed to improve the functional results of myringoplasty in children with cleft palate.
Objectives:
To assess the anatomic and functional outcome of underlay cartilage myringoplasty in children with cleft palate, at different postoperative periods compared with a patients-matched control group
Study Design:
Case control study, tertiary referral center.
Methods:
An otologic database was used to select children with cleft palate and perforated tympanic membrane who underwent myringoplasty between 1995 and 2012. These subjects were matched with control patients, without cleft palate, using the following criteria: age, size of perforation, status of contralateral ear, and status of middle ear mucosa. Charts were reviewed for the following: patients characteristics, preoperative findings, surgical data, postoperative anatomic and functional outcomes, and reinterventions. The postoperative findings were divided into 5 different periods.
Results:
A group of 32 cleft palate patients as well as 32 control patients were included in this study, with a mean follow up of 63.6 ± 41 months. There were no differences between the groups in anatomic success as it was achieved in 84% in both groups. No differences were seen in functional outcome when compared with each different postoperative period. Using the last available audiogram, the postoperative mean air conduction and the air-bone gap were significantly worse in the cleft group compared with the control group, respectively, 26.1 ± 13.7 dB versus 18.4 ± 10.1 dB, p = 0.042; and 16.5 ± 9.4 dB and 11.3 ± 6.4 dB, p = 0.046. Additionally, the functional success was significantly worse in the cleft group; 58% versus 87% in the control group (OR, 5.5 [95% CI, 1.22-24.81], p = 0.027).
Conclusion:
Children with cleft palate can benefit from cartilage underlay myringoplasty in terms of closure of tympanic membrane, although there is a worse functional outcome.
