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Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis
John Hardman1, Jameel Muzaffar, Paul Nankivell
1*Department of Otolaryngology Head and Neck Surgery, University Hospital Coventry and Warwickshire, Coventry; †Department of Otolaryngology Head and Neck Surgery, Birmingham City Hospital, Birmingham; and ‡Department of Otolaryngology Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, U.K.
Insights
Type 1 tympanoplasty in children has an 83.4% success rate for chronic eardrum perforations. Larger perforations and contralateral ear issues decrease success, suggesting delayed surgery may be beneficial.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Evidence-Based Medicine
Background:
- Chronic tympanic membrane perforations are common in children.
- Tympanoplasty is a surgical option to repair these perforations.
- Understanding factors influencing success in pediatric patients is crucial for optimal outcomes.
Purpose of the Study:
- To evaluate the effectiveness of Type 1 tympanoplasty in children.
- To identify factors impacting the success rate of pediatric tympanoplasty.
Main Methods:
- Systematic literature search of MEDLINE and Cochrane Database of Systematic Reviews.
- Inclusion of studies on tympanoplasty in patients 18 years or younger with ≥6 months follow-up.
- Exclusion of advanced tympanoplasty techniques and revision surgeries.
Main Results:
- A pooled closure rate of 83.4% was observed for pediatric tympanoplasty.
- Factors associated with lower success rates included larger perforation size and abnormal contralateral ear findings.
- Age was not found to be a significant predictor of surgical success.
Conclusions:
- Type 1 tympanoplasty demonstrates a high success rate in the pediatric population.
- Surgical outcomes are influenced by perforation size and the condition of the contralateral ear.
- Consideration should be given to delaying surgery until associated conditions like otitis media with effusion have resolved.
Objective:
To study the effectiveness of Type 1 tympanoplasty for chronic tympanic membrane perforations in the pediatric age group and to investigate factors influencing its success.
Data Sources:
Searches were conducted of the MEDLINE database and the Cochrane Database of Systematic Reviews using terms focused around tympanoplasty and children. Searches were performed on June 23, 2014 and limited to English language entries since January 1, 1997.
Study Selection:
Studies reporting tympanoplasty closure rates in children 18 years and younger, with a minimum follow-up of 6 months, were included. Studies focusing on more advanced forms of tympanoplasty and revision surgery were excluded.
Data Extraction:
Five hundred sixty-four articles were screened identifying 2,609 cases from 45 eligible studies. Data were collected by consensus of the first two authors with the third author arbitrating disparities of opinion. Success was taken as the closure rate at 12 months where possible.
Data Synthesis:
Forest plots with Mantel-Haenszel analyses were used to compare closure rates with respect to perforation size, adenoidectomy, status of contralateral ear, Eustachian tube function, active infection, and graft position. Linear regression and Fisher's exact were used to analyze closure rate with respect to age.
Conclusion:
The mean weighted closure rate for pediatric tympanoplasty was 83.4%. Subgroup analysis found age not to be a significant factor affecting the closure rate. Tympanoplasties performed on larger perforations or in children with abnormal contralateral ear findings were more likely to fail. Surgery may be best delayed until contralateral otitis media with effusion has settled.
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