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Evaluating butterfly inlay tympanoplasty
Ryan S Ference1, James A Leonard1, Michael S Weinstock2
1Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
Insights
Butterfly tympanoplasty (BT) offers similar closure rates and hearing improvement compared to underlay tympanoplasty (UT) in children. This technique also significantly reduces operative time for pediatric otolaryngologists.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Techniques
Background:
- Tympanoplasty is a common surgical procedure to repair tympanic membrane perforations.
- Underlay tympanoplasty (UT) is a widely used technique, but operative times can be lengthy.
- Exploring alternative techniques like butterfly tympanoplasty (BT) may offer advantages.
Purpose of the Study:
- To compare the efficacy of butterfly tympanoplasty (BT) versus underlay tympanoplasty (UT) in pediatric patients.
- Key outcome measures include perforation closure rate, air-bone gap reduction, and operative time.
Main Methods:
- A retrospective cohort study was conducted on pediatric patients (<18 years) undergoing Type I tympanoplasty between 2009 and 2017.
- Patients with less than 6 months follow-up, mastoidectomy, fat graft, or cholesteatoma were excluded.
- Data on perforation size, air-bone gap, operative time, and closure rates were analyzed.
Main Results:
- The study included 21 patients for BT and 41 for UT, with similar mean ages.
- Operative time was significantly reduced in the BT group (94.0 min) compared to the UT group (150.9 min) (p=0.01).
- Both techniques demonstrated similar perforation closure rates (BT: 85.7%, UT: 75.6%) and comparable reductions in air-bone gap across tested frequencies.
Conclusions:
- Butterfly tympanoplasty (BT) is a reliable and effective surgical option for pediatric tympanic membrane perforations.
- BT achieves comparable closure rates and hearing improvement to UT while offering a significant reduction in operative time.
- This suggests BT is a valuable tool for pediatric otolaryngologists.
Objective:
To compare closure rate, reduction in air-bone-gap, and operative time of butterfly tympanoplasty (BT) to underlay tympanoplasty (UT).
Methods:
Retrospective cohort study of children (age <18y) undergoing Type I tympanoplasty between 2009 and 2017. Patients were excluded if they had <6 months of follow up, mastoidectomy, fat graft or cholesteatoma.
Results:
Twenty-one patients (mean age 13.4) underwent BT while forty-one patients (mean age 13.5) underwent UT. The mean size of perforation in 30.6% in BT patients and 43.6% in UT patients (p = 0.01). Preoperative audiogram showed a similar air-bone-gap between the two groups of 31.7, 22.7, and 17.9 dB in BT vs 29.6, 24.8, and 17.6 dB in UT at 500, 1000, and 2000 Hz, respectively (p = 0.65, 0.63, and 0.94). Operative time was reduced in BT as compared to UT (94.0 min vs. 150.9, p = 0.01). Closure rate was similar at 85.7% in BT vs 75.6% in UT patients (p = 0.40). Average reductions in air-bone gap were similar with 19.2, 11.7, and 13.2 dB for BT vs 16.6, 12.1, and 10.3 dB for UT at 500, 1000, and 2000 hz, respectively (p = 0.66, 0.93, 0.40).
Conclusion:
BT has become a reliable tool for the pediatric otolaryngologist. This retrospective study shows that pediatric BT results in similar outcomes with reduced operative time.
