Pediatric myringoplasty: a study of factors affecting outcome

Abstract

Objectives: To analyze the success rates of myringoplasty in children, to assess prognostic factors and to evaluate their interactions in the evolution of myringoplasty.

Methods: Charts of patients who had undergone a myringoplasty between 1997 and 2007 were reviewed for: patient age, sex, perforation side, etiology, size, type and location of perforation, season of surgery, type of myringoplasty, surgical technique, graft material, preoperative status of the operated and contralateral ear, history of otologic surgery to the operated and/or contralateral ear, number of prior surgeries to the operated and contralateral ear, time elapsed between the last otologic procedure and this myringoplasty, history of adenoidectomy or tonsillectomy, time elapsed between the adenoidectomy or tonsillectomy and this myringoplasty. Anatomical success was defined as postoperative intact tympanic membrane(TM). Audiological success was defined as air bone gap less than 20 dB and a postoperative difference of no more than 10 dB in the mean bone conduction (BC) threshold.

Results: A total of 201 cases of myringoplasty were operated between 1997 and 2007. Anatomical success rates were 94.9%, 84.9% and 70.1% at 6, 12 and 24 months, respectively. The type of previous otologic surgery in the operated ear was found statistically significant for anatomical success. Audiological success rates were attained in 97.4%, 93.4% and 84.9% of patients at 6, 12 and 24 months, respectively. A mean reduction of 9.1 dB of the air bone gap was achieved postoperatively. No sensorineural hearing loss occurred. Children 12 years and older presented with statistically poorer preoperative BC at frequencies ≥2000 Hz when compared to their younger counterparts. These results suggest that the chronicisation of the TM perforation can result in long-term irreversible damage to the inner ear.

Conclusion: The type of previous otologic surgery in the operated ear was found to have an impact on anatomical success. The outcome for myringoplasty was more favourable when the etiology of the previous surgery was a benign one. We advocate early myringoplasty, preferably above the age of 6. Delaying surgery can cause permanent damage to the inner ear. All other factors evaluated were not found to be statistically significant for anatomical or audiological success.