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Predictive factors of long-term tympanoplasty outcomes in children with cleft palate
Jamie L Funamura1, Travis T Tollefson1, Angela Colback1
1Department of Otolaryngology-Head & Neck Surgery, University of California - Davis School of Medicine, 2521 Stockton Blvd., Suite 7200, Sacramento, CA, 95817, United States.
Insights
Tympanoplasty in children with cleft palate has a 78% success rate. Assessing the other ear
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Craniofacial Anomalies
Background:
- Chronic ear infections and perforations are common in children with cleft palate.
- Successful tympanoplasty is crucial for hearing and speech development in this population.
Purpose of the Study:
- To identify factors predicting long-term success of tympanoplasty in pediatric patients with cleft palate.
- To analyze the impact of various clinical and demographic factors on surgical outcomes.
Main Methods:
- Retrospective review of 50 tympanoplasty procedures in children (<18 years) with cleft palate over 20 years.
- Comparison of demographic and clinical characteristics based on surgical outcomes (success, reperforation, need for tubes/revision).
- Application of univariate, survival, and multivariate analyses to identify predictors of success.
Main Results:
- Overall primary tympanoplasty success rate was 78% with a mean follow-up of 5.7 years.
- Ability to assess contralateral ear function was significantly associated with a longer duration of successful repair (10.7 vs. 8.2 years, p=0.02).
- Contralateral ear assessment increased the likelihood of successful tympanoplasty by 5.4 times.
Conclusions:
- Tympanoplasty success rates in children with cleft palate are lower than in the general population but remain achievable.
- Assessing the contralateral ear's status is a key predictor of tympanoplasty success, potentially more so than age or cleft type.
- Further research should focus on optimizing surgical strategies based on Eustachian tube function assessment.
Objective:
Identify factors associated with long-term tympanoplasty success in children with cleft palate.
Methods:
All tympanoplasty procedures for chronic perforation in children with cleft palate at a single institution were reviewed over a 20-year period. Demographic and clinical characteristics were compared by tympanoplasty outcome - successful sustained repair versus reperforation or tympanostomy tube placement versus need for revision tympanoplasty - with univariate, survival, and multivariate analysis.
Results:
A total of 50 initial tympanoplasty procedures for chronic perforation between 2004 and 2024 at a single institution met inclusion criteria of patients <18 years with a history of cleft palate, excluding revision and second-sided procedures. The overall success rate of primary tympanoplasty was 78 % with a mean length of follow-up of 5.7 (±3.6) years. Significant demographic and clinical predictors were not demonstrated by univariate analysis. However, survival analysis of time to tympanoplasty failure demonstrated differences in duration of successful tympanoplasty for children in which Eustachian tube function could be assessed by the status of the contralateral ear, with a mean time to failure of 10.7 [9.5-12.0] compared to 8.2 [5.3-11.0] years (p = 0.02). Ability to assess the contralateral ear was also associated with a 5.4 (1.1.-26.1) increased likelihood of a successful tympanoplasty outcome.
Conclusion:
The success rate of tympanoplasty in children with cleft palate is lower than would be expected in an adult or non-cleft population, but can still be largely successful at a mean age of <12 years. The ability to assess the contralateral ear may the most important predictive factor in determining success rather than age, cleft type, or other demographic and clinical factors.
