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A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis
P Naina1, Apar Pokharel1, Kamran Asif Syed1
1Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India.
Insights
A three-point assessment for pediatric chronic otitis media (COM) surgery shows over 90% graft uptake. This method helps predict successful tympanoplasty outcomes in children with mucosal type COM.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Outcomes Research
Background:
- Chronic otitis media (COM) of the mucosal type in children presents challenges, particularly with recurrent tympanic membrane perforations.
- Predicting surgical success in pediatric tympanoplasty is crucial for effective management.
Purpose of the Study:
- To evaluate the surgical outcome of tympanoplasty in pediatric patients diagnosed with chronic otitis media of the mucosal type.
- To assess the efficacy of a three-point predictive model for tympanoplasty success in children.
Main Methods:
- Retrospective analysis of medical records for children under 16 who underwent tympanoplasty for mucosal type COM.
- Assessment included patient age, nasal/pharyngeal issues, and COM status (discharging or dry).
- Surgical success evaluated by graft uptake and hearing improvement; factors influencing outcomes were analyzed.
Main Results:
- Of 73 analyzed tympanoplasties, 91.7% achieved graft uptake.
- Children over 8 years old had a significantly higher chance of graft uptake (p=0.021).
- Longer duration of ear discharge correlated with greater hearing loss; graft rejection was noted in children with bilateral disease.
Conclusions:
- A three-point assessment model effectively predicts successful tympanoplasty outcomes in pediatric patients with mucosal type COM.
- The proposed assessment strategy yields high graft uptake rates exceeding 90%.
Abstract:
Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake ( p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.
