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Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty
Sebastian C Ranguis1, Colin G Leonard, Adrian L James
1Department of Otolaryngology, Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Objective:
To compare outcomes and complications of endoscopic lateral graft (LGT) and interlay (IT) tympanoplasty.
Study Design:
Prospective observational cohort study of totally endoscopic ear surgery (TEES) tympanoplasty.
Setting:
Pediatric tertiary referral center.
Patients:
One hundred fourteen surgeries for children with tympanic membrane perforation without cholesteatoma.
Intervention:
Porcine-derived collagen graft tympanoplasty using either LGT or IT.
Main Outcome Measures:
Closure rates of perforation, hearing outcomes (four-tone average air conduction [AC] and air bone gap), and complications that required further surgery were assessed 12 months postoperatively.
Results:
Perforation closure rates did not differ between LGT (52/59 (88%)) and IT (45/51 (88%)), (Fisher's exact p = 1.00) (four ears lost to follow-up). AC thresholds (p = 0.32) and air bone gap (p = 0.88) improved similarly after surgery with LGT (median 8.8 dB) and IT (median 7.5 dB). The proportion of ears with serviceably normal hearing (AC ≤ 30 dB HL) postoperatively was similar (LGT 40/49 (82%), IT 36/46 (78%), Fisher's exact p = 0.80). Following IT, three (6%) ears developed inclusion cholesteatoma requiring revision surgery. One (2%) LGT ear developed blunting after myringitis.
Conclusions:
IT and LGT provide similar perforation closure rates and hearing outcomes. When choosing between these two techniques to repair pediatric tympanic membrane perforations, LGT would seem to be preferable than IT due to the risk of inclusion cholesteatoma after IT. There is a small risk of anterior blunting after LGT.
