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Role of Mastoidectomy with Type 1 Tympanoplasty in Paediatric Patients with Poor Contralateral Ear Status
Mohan Raghav Guthikonda1, Aswini Gude2, Rahul Naga3
1Department of Otorhinolaryngology-Head and Neck Surgery, 166 Military Hospital, Satwari Cantonment, Jammu, Jammu and Kashmir 180003 India.
Insights
Adding mastoidectomy to type 1 tympanoplasty significantly improves outcomes for children with poor hearing in the other ear. This combined approach enhances overall success, particularly in younger children (≤8 years).
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Outcomes
Background:
- Management of pediatric patients with bilateral ear perforations and poor contralateral ear status presents challenges.
- Type 1 tympanoplasty is a common surgical intervention for such cases.
Purpose of the Study:
- To evaluate the efficacy of combining mastoidectomy with type 1 tympanoplasty in pediatric patients with poor contralateral ear status.
- To identify prognostic factors influencing the success of type 1 tympanoplasty.
Main Methods:
- A prospective study involving 112 pediatric patients (4-12 years) with bilateral ear perforations.
- Random assignment to either type 1 tympanoplasty or type 1 tympanoplasty with mastoidectomy.
- Outcomes assessed at 12 months included tympanic membrane condition, hearing improvement, middle ear status, and overall success.
Main Results:
- Mastoidectomy group showed significantly higher success in tympanic membrane anatomical condition (p=0.015) and air-filled middle ear space (p<0.001).
- Overall success was significantly higher in the mastoidectomy group for all patients (p=0.040) and those ≤8 years (p=0.012).
- Type of ear surgery performed was the only significant predictor of success (AUC=0.606, p=0.046).
Conclusions:
- Combining cortical mastoidectomy with type 1 tympanoplasty offers statistically significant higher overall success in pediatric patients with poor contralateral ear status.
- This combined approach is particularly recommended for pediatric patients aged 8 years and younger.
- Prognostic factors other than the surgical approach did not significantly influence success outcomes.
Abstract:
The aim of the study was to assess the role of mastoidectomy with type 1 tympanoplasty in the management of paediatric patients with poor contralateral ear status and to evaluate the prognostic factors that may influence the success outcome of type 1 tympanoplasty. A prospective study of 112 paediatric patients from 4 to 12 years of age. All patients in the study had bilateral ear perforations. They were randomly assigned to undergo either type 1 tympanoplasty (group 1, n = 56) or type 1 tympanoplasty with mastoidectomy (group 2, n = 56). The outcomes between the two groups were compared at 12 months postoperative period. The outcomes evaluated were: 1. anatomical condition of the tympanic membrane, 2. functional improvement in hearing (≥ 10 db), 3. air-filled middle ear space without atelectasis or otitis media with effusion, 4. overall outcome. The outcomes were also compared in both the surgical groups for patients who were ≤ 8 years (n = 51) and > 8 years (n = 61) of age. Prognostic factors for success outcome for type 1 tympanoplasty were evaluated. The prognostic factors considered were age at the time of surgery, age groups, duration of the disease prior to surgery, previous adenoidectomy, mechanism of perforation, location of perforation, size of the perforation, type of ear surgery performed (tympanoplasty with or without mastoidectomy). The success outcome in anatomical condition of the tympanic membrane was significantly higher in mastoidectomy group (p = 0.015) but was not significantly different in those ≤ 8 years and > 8 years (p = 0.112, p = 0.064 respectively).There was no difference in the functional improvement in hearing in both the surgical groups for all patients, ≤ 8 years and > 8 years (p = 0.188 p = 0.061, p = 0.865 respectively). Mastoidectomy group showed significantly higher success outcome for air-filled middle ear space without atelectasis or OME for all patients, ≤ 8 years and > 8 years (p < 0.001, p = 0.004, p = 0.041 respectively).Overall success was significantly higher in mastoidectomy group for all patients and ≤ 8 years (p = 0.040, p = 0.012 respectively),but not significantly different for > 8 years (p = 0.592).Out of the prognostic factors considered for success only the type of ear surgery performed showed as a better predictor for success (AUC = 0.606, p = 0.046). Cortical mastoidectomy done along with type 1 tympanoplasty in paediatric patients with poor contralateral ear showed statistically significant higher overall success outcome. Although mastoidectomy done with type 1 tympanoplasty showed better success outcome in patients above 8 years, it was not statistically significant. Except the type of ear surgery performed, none of the prognostic factors considered could influence the success outcome. Our study recommends mastoidectomy to be combined with type 1 tympanoplasty in paediatric patients aged ≤ 8 years with poor contralateral ear status to enhance the overall success outcome.
