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Results of pediatric tympanoplasty on short-term surgical missions
Glenn Isaacson1,2, Abebe Melaku3
1Department of Otolaryngology-Head & Neck Surgery.
Insights
Pediatric tympanoplasty on medical missions is safe, with good hearing improvement. However, human immunodeficiency virus (HIV)-positive children experienced higher graft failure rates and persistent ear drainage.
Area of Science:
- Otolaryngology
- Global Health
- Pediatric Surgery
Background:
- Pediatric tympanoplasty is crucial for addressing hearing loss in children.
- Short-term international medical missions offer surgical opportunities in underserved regions.
- Evaluating surgical outcomes in diverse settings is essential for improving global pediatric ear care.
Purpose of the Study:
- To assess the safety and effectiveness of pediatric tympanoplasty conducted during short-term international medical missions.
- To compare outcomes with established surgical benchmarks.
Main Methods:
- A prospective observational study was conducted on Ethiopian children undergoing tympanoplasty.
- Procedures involved postauricular tympanoplasty with temporalis fascia grafts.
- Pre- and postoperative audiometry, complication assessment, and 6-month follow-up were performed.
Main Results:
- Of 44 ears, 24 achieved an intact tympanic membrane, and 12 had reduced perforations.
- Mean improvement in pure-tone average (PTA) was 14 dB.
- Human immunodeficiency virus (HIV)-positive children showed significantly higher graft failure (3/4) and persistent otorrhea rates (3/6).
Conclusions:
- Pediatric tympanoplasty can be safely performed in short-term mission settings with appropriate standards.
- Outcomes were comparable to developing-world hospitals but lower than in Western series.
- HIV status is a significant factor influencing graft success and ear dryness post-tympanoplasty.
Objectives/Hypothesis:
To determine the safety and effectiveness of pediatric tympanoplasty performed on short-term international medical missions.
Study Design:
Prospective observational study.
Methods:
Ethiopian children who had dry or nearly dry tympanic perforations and bilateral conductive hearing losses underwent postauricular tympanoplasties with underlain temporalis fascia grafts. Pre- and postoperative air and bone audiometry was performed. Complications, graft success, hearing improvement, and dry ear at 6-month follow-up were evaluated.
Results:
Patients were 7 to 25 years old (24 female ears, 20 male ears). The majority had subtotal perforations. Operative findings included ossicular erosions and fixation by hypertrophic mucosa. There were no major medical complications or deaths in this series. Of 44 ears, 27 had complete pre- and postoperative audiometric data. Twenty-four of 44 surgeries resulted in an intact tympanic membrane. Twelve of 44 markedly reduced the perforation. Eight of 44 grafts failed. The mean improvement in PTA was 14 dB (range = -6-45 dB). Human immunodeficiency virus (HIV)+ patients had a high rate of graft failure (3/4) and comprised 38% (3/8) of complete graft failures (P = .015). Among the 20 ears with residual perforations, 14 were dry at 6-month follow-up. Of the six ears with drainage, three were HIV+ (P = .019).
Conclusions:
Pediatric tympanoplasty is a safe procedure in a short-term surgical mission setting when high anesthetic and surgical standards are maintained. Surgical results were similar to those found in developing-world university hospitals, but were worse than in United States or European series. HIV+ children did worse than their HIV-/unknown peers, with a high rate of graft failure and persistent otorrhea.
Level Of Evidence:
4. Laryngoscope, 126:1464-1469, 2016.
