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Fasciaform myringoplasty in children
R R MacDonald1, R P Lusk, H R Muntz
1St Louis Children's Hospital, Mo.
Insights
Fasciaform myringoplasty successfully repaired large tympanic membrane perforations in children, improving hearing. However, younger children had higher reperforation rates, suggesting conservative management is needed.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Regenerative Medicine
Background:
- Large tympanic membrane perforations in children pose challenges for hearing restoration.
- Traditional repair methods may have limitations in pediatric cases.
Purpose of the Study:
- To assess the effectiveness of fasciaform myringoplasty for large tympanic membrane perforations in pediatric patients.
- To evaluate hearing outcomes and complications associated with this procedure.
Main Methods:
- Retrospective review of 26 children (5-16 years) undergoing 29 fasciaform myringoplasty procedures.
- The technique involves creating a new tympanic membrane from autogenous temporalis fascia.
- Outcomes analyzed included successful closure, hearing improvement, and complications.
Main Results:
- Successful closure achieved in 69% of cases.
- Significant hearing improvement (PTA < 20 dB HL) in 77% and air-bone gap reduction (within 20 dB HL) in 90% of cases with complete data.
- Recurrent otitis media (52%) and reinsertion of ventilation tubes (24%) were noted.
Conclusions:
- Fasciaform myringoplasty is effective for closing large tympanic defects and enhancing hearing in children.
- Recurrent otitis media and eustachian tube dysfunction remain concerns.
- Higher reperforation rates in children ≤7 years old indicate a need for conservative management in this subgroup.
Objective:
To evaluate the efficacy of fasciaform myringoplasty as a means to repair large tympanic membrane perforations in children.
Design:
Retrospective review of the records of 26 patients who underwent 29 consecutive fasciaform myringoplasty surgeries over a 47-month period. Patients were followed up from 2 to 47 months postoperatively.
Setting:
Academic tertiary care children's hospital.
Participants:
Twenty-six patients (5 to 16 years old), with tympanic membrane perforations (25% to 95%) underwent a fasciaform myringoplasty procedure. The perforations were caused by extrusion of ventilation tubes (83%), deep retraction pockets, trauma, or repair after resection of cholesteatoma.
Intervention:
The surgery involves resection of the native tympanic membrane and annulus. A new tympanic membrane is formed from formaldehyde-fixed autogenous temporalis fascia and positioned.
Outcome Measure:
Successful repairs, complications, and audiometric evaluations were analyzed. Fisher's Exact Test was used to compare complication rates by age.
Results:
Successful closure was accomplished in 69% of cases. Otitis media recurred in 52%. Ventilation tubes were reinserted in 24%; 28% resolved with antibiotics alone. When tubes were placed through the graft, small residual graft perforations resulted. Audiometric evaluation revealed improvement in pure tone average to less than a 20-dB hearing level in 77% and reduction of the air-bone gap to within a 20-dB hearing level in 90% of those cases (10/29) with complete audiometric data.
Conclusions:
Fasciaform myringoplasty has proven to be a successful procedure for closing large tympanic defects and improving hearing acuity in the pediatric population. However, recurrent otitis media and eustachian tube dysfunction may continue. Rates of reperforation were statistically significantly higher in children 7 years old and younger. Conservative management of children in this younger age group is warranted.
