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Pediatric myringoplasty: A study of effectiveness and influencing factors
Ina Foulon1, Dylen Philips1, Elke Lichtert1
1Department of Otolaryngology- Head and Neck Surgery, Belgium.
Insights
Myringoplasty is a safe and successful surgery for children with eardrum perforations. Large perforations may benefit from cartilage techniques, but surgery postponement is generally not advised.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Outcomes
Background:
- Myringoplasty is a common surgical procedure for eardrum perforations in children.
- Optimal surgical timing and technique remain debated due to a lack of consensus on prognostic factors.
- Understanding factors influencing surgical success is crucial for improving pediatric ear surgery outcomes.
Purpose of the Study:
- To evaluate prognostic factors for myringoplasty outcomes in children.
- To determine the ideal age and surgical approach for pediatric tympanoplasty.
- To identify factors that may necessitate postponing surgery or using alternative techniques.
Main Methods:
- Retrospective analysis of 97 pediatric myringoplasty cases.
- Standardized surgical technique: retro-auricular approach with microscopic underlay fascia graft.
- Exclusion of cases with cholesteatoma, revision surgery, or ossicular defects; minimum 12-month follow-up.
Main Results:
- Overall success rate of 80.2% for myringoplasty.
- Perforation size was a significant negative prognostic factor (42.9% closure for large perforations).
- History of adenoidectomy positively impacted tympanic closure (p=0.047); age was not significant.
Conclusions:
- Myringoplasty using temporalis fascia is safe and effective for pediatric eardrum perforations across all ages.
- Consider cartilage tympanoplasty for large perforations.
- Avoid postponing surgery unless Eustachian tube dysfunction or adenoid hyperplasia is present.
Objectives:
Until today, there is no consensus about the ideal age for a myringoplasty in children. In this retrospective study, we study our own series to characterize different prognostic factors to answer questions/dilemmas such as when to carry out surgery in a child with an ear drum perforation, when to postpone surgery or when to use a different technique to improve the outcome after tympanoplasty.
Methods:
We performed a retrospective study on charts of 97 children who underwent a myringoplasty. The same surgeon (IF) treated all included children and with the same classical surgical technique: retro-auricular approach and microscopic underlay placement of fascia of the musculus temporalis. Children with associated disease (cholesteatoma, revision surgery and ossicular chain defects) were excluded. All children had a minimum follow up of 12 months. A successful procedure was defined as a closed eardrum after 12 months and an air bone gap <20 dB. Prognostic factors were inventoried and studied.
Results:
Success rate after myringoplasty is 80.2% in this pediatric case series. Age was not a statistical significant prognostic factor. Only the history of an adenoidectomy had a positive effect on tympanic closure (p = 0.047). A negative prognostic factor was the size of the perforation: large perforations showed only 42.9% eardrum closure (p = 0.040). There was a complication rate of 28.9%, in which formation of granulation tissue and ear discharge were most common but easily treated.
Conclusion:
Tympanoplasty type 1 with musculus temporalis fascia in underlay is a safe and successful technique in children of all ages with eardrum perforations. Our data suggests using a different technique (cartilage tympanoplasty) in cases with large perforation. Postponing surgery is not advocated, unless perhaps in children with poor Eustachian function or adenoidhyperplasia.
