Preventive tympanoplasty in children: a new approach

Chronic middle ear effusion with serous or mucus accumulation but without other associated tympanic and middle ear pathology can be successfully treated in many cases with myringotomy and ventilating tubes. But there are cases on which there are atrophic tympanic membrane areas with retraction into the middle ear, tympanic membrane adhesions to the long process of incus and incudo-stapedial joint with or without retraction toward the facial and tympanic recesses and shallow attic retraction pockets, which eventually will lead to cholesteatoma formation. All these minor anatomical distortions are usually asymptomatic, but with a potential to generate cholesteatomas throughout the years and cannot be corrected with a simple myringotomy and ventilation tube insertion. In these particular cases we have developed some types of tympanoplasty procedure that may prevent further progression to cholesteatoma formation. The purpose of this presentation is to describe these preventive tympanoplasty techniques and analyze the short and long term results in 68 surgical procedures.