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Pediatric tympanoplasty of iatrogenic perforations from ventilation tube therapy
G O Te1, F M Rizer, A G Schuring
1Warren Otologic Group, Ohio 44484-4791, USA.
Insights
Tympanoplasty is successful for children with iatrogenic perforations from ventilation tubes. Outcomes are not affected by patient age, surgical technique, or preoperative factors.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Outcomes
Background:
- Iatrogenic perforations can occur after ventilation tube insertion for otitis media with effusion (OME).
- Persistent tympanic membrane perforations require surgical repair, such as tympanoplasty.
Purpose of the Study:
- To evaluate the surgical outcomes of tympanoplasty in children with iatrogenic perforations.
- To determine the influence of age, preoperative factors, and surgical technique on tympanoplasty success.
Main Methods:
- Retrospective review of 93 pediatric patients undergoing tympanoplasty for iatrogenic perforations.
- Underlay or overlay tympanoplasty using temporalis fascia grafts.
- Outcomes assessed by graft healing, hearing improvement (air-bone gap), and complications.
Main Results:
- A high graft take-rate of 94.6% was observed with a mean follow-up of 16.8 months.
- Significant hearing improvement was achieved, with 94.7% of patients closing their air-bone gap to within 20 dB.
- Surgical outcomes were not significantly influenced by patient age, surgical technique, or preoperative factors.
Conclusions:
- Tympanoplasty is a successful surgical option for persistent perforations following ventilation tube therapy.
- The success of tympanoplasty in this pediatric population is independent of age, surgical approach, or specific preoperative conditions.
Objectives:
This study aimed to determine surgical outcome of tympanoplasty in children with iatrogenic perforations, to determine whether age is a factor in successful tympanoplasty, and to determine whether surgical outcome is affected by preoperative factors (e.g., perforation size and location, otorrhea, cholesteatoma, and tympanosclerosis) or surgical technique (e.g., underlay or overlay).
Study Design:
The study design was a retrospective series review.
Setting:
The study was conducted at a multiphysician private otologic practice.
Patients:
Ninety-three pediatric patients with iatrogenic perforations caused by the insertion of ventilation tubes for otitis media with effusion (OME) participated. Surgical selection criteria included a year's observation of the perforation with a 6-month OME-free interval in the involved and contralateral ear. The 46 males and 47 females had a mean age at surgery of 10.8 years (standard deviation = 2.9) ranging from 3-16 years.
Interventions:
All patients underwent underlay or overlay tympanoplasty using temporalis fascia grafts.
Main Outcome Measures:
Outcome was evaluated in terms of drum healing (healed or perforated), hearing (air-bone gap), and complications.
Results:
There was a graft take-rate of 94.6% with reperforations occurring in 5.4% with an average follow-up of 16.8 months. Duration of follow-up ranged from 10.8-77.5 months. The air-bone gap was completely closed in 53.8% and was closed to within 10 dB in 80.7% and 20 dB in 94.7%. The incidence of major and minor complications was 16.1%. Surgical outcome was not influenced by age, technique, or any of the preoperative factors.
Conclusions:
Tympanoplasty of persistent perforations after ventilation tube therapy for recurrent OME can be performed successfully regardless of age, surgical technique, or other preoperative factors.