Endoscopic type 1 tympanoplasty in pediatric patients using tragal cartilage

Abstract

Importance: The main objective in the treatment of chronic otitis media is to relieve drainage and to rehabilitate hearing. Various materials can be used to repair the tympanic membrane (TM) through different tympanoplasty techniques.

Objective: To assess the results of endoscopic type I tympanoplasty in pediatric patients using tragal cartilage as a grafting material.

Design, setting, and participants: In this prospective study, we studied 80 ears in 80 pediatric patients (ages, 5-17 years) who had undergone type I tympanoplasty from January 2011 to December 2013 at a tertiary referral hospital. We classified our patients into a younger group (≤10 years; n = 40) and an older group (>10 years; n = 40). Patients were followed for up to 6 months.

Interventions: Endoscopic type I tympanoplasty using split-thickness tragal cartilage.

Main outcomes and measures: We identified the following criteria for success: (1) healing of the TM (anatomical success) and (2) improvement in hearing by assessing the change in the air-bone gap (ABG). We also assessed the mean operation duration and the different prognostic factors.

Results: Healing of the TM healing occurred in 34 patients (85%) in the younger group vs 36 patients (90%) in the older group. Both groups had notable improvement compared with the preoperative measurements, with no significant differences between the 2 groups. Thirty patients (75%) in the younger group had improvement in their ABG vs 32 patients (80%) in the older group, with a mean ABG of 8.0 dB and 10.5 dB in the younger and older groups, respectively. Both groups had significant functional success with no significant differences between the 2 groups. Sixty patients (75%) displayed a type A tympanogram at their 6-month postoperative audiometric testing (28 patients in the younger group vs 32 patients in the older group). There were no statistically significant differences regarding the anatomical and functional success between the patients who had previously undergone adenotonsillectomy and the other patients. The mean (SD) operation duration was 55.03 (2.50) minutes.

Conclusions and relevance: In pediatric patients undergoing type I tympanoplasty, the endoscopic approach using the tragal cartilage as a grafting material resulted in successful anatomical and functional outcomes that are in comparable to other techniques but with a shorter operation duration. Age of the patient, auditory tube dysfunction, and previous adenotonsillectomy were not prognostic factors for this procedure.