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Pediatric tympanoplasty. A 10-year experience
S S Chandrasekhar1, J W House, U Devgan
1Section of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
Insights
Tympanoplasty is safe and effective in children, with age not impacting healing outcomes. Factors like mastoidectomy and prior surgeries can affect success rates in pediatric tympanoplasty.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Tympanoplasty is a common surgical procedure for hearing restoration.
- Understanding factors influencing pediatric tympanoplasty outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the impact of child's age on tympanoplasty healing.
- To identify other factors influencing surgical outcomes in pediatric tympanoplasty.
Main Methods:
- Retrospective case series of 318 patients under 20 years undergoing tympanoplasty.
- Patients analyzed in four age groups: <7, 7-8, 9-12, and 13-19 years.
- Outcomes assessed based on graft healing, hearing, and overall success (intact graft, air-bone gap <25 dB).
Main Results:
- Overall success rate of 81% for tympanoplasty.
- 92.5% graft intactness and 84% achieved desired air-bone gap.
- No significant difference in outcomes was found across the four age groups.
Conclusions:
- Tympanoplasty is a safe and effective procedure for children.
- Factors such as mastoidectomy and previous tympanoplasty negatively impact success.
- Age is not a determining factor in pediatric tympanoplasty outcomes.
Objectives:
To determine if the age of the child is a factor in healing after tympanoplasty and to find other factors that affect the outcome in these patients.
Design:
Case series by retrospective otological chart review.
Setting:
A group private practice otology and neuro-otology referral center.
Patients And Other Participants:
A consecutive sample of all patients younger than 20 years who had tympanoplasty performed at the House Ear Clinic between January 1, 1983, and January 1, 1993. The 318 patients, who had had 381 ears operated on, were separated into four age groups: younger than 7 years, 7 to 8 years, 9 to 12 years, and 13 to 19 years. The 268 patients who had follow-up examinations for 6 months or longer after tympanoplasty are grouped in the same age categories for outcomes analysis.
Interventions:
None.
Main Outcome Measures:
Preoperative and postoperative audiometric data and otologic examination at the final follow-up examination. Results are reported for hearing, healing, and "success," which combines hearing and healing and is defined as an intact graft with a postoperative air-bone gap of less than 25 dB.
Results:
The operation resulted in an intact graft in 92.5% of ears and a postoperative air-bone gap less than 25 dB in 84% of ears. Success was achieved in 81% of ears. No difference in outcome was observed among the four age groups. Success was negatively affected by mastoidectomy, previous tympanoplasty, and use of total ossicular replacement prosthesis ossiculoplasty; perhaps by the number of previous myringotomy and tubes; but not by age, status of the contralateral ear, middle ear discharge, or fellow as primary surgeon.
Conclusion:
Tympanoplasty can be safely and effectively performed in children.