Singh Gautam Bir, Sidhu T S, Sharma Arun, Singh Nitasha
Department of ENT and HNS, Institute of Medical Sciences and S.S Hospital, BHU, Varanasi, India.
Int J Pediatr Otorhinolaryngol. 2005 Aug;69(8):1071-6. doi: 10.1016/j.ijporl.2005.02.016. Epub 2005 Mar 20.
A considerable controversy surrounds the subject of paediatric tympanoplasty type I. Conflicting views regarding timing of surgery and various other factors like Eustachian tube, status of contralateral ear, site and type of perforation etc. are presented by various published case series in medical literature. However, very few prospective studies address the issue. Thus, a prospective study was planned to evaluate the success rate of paediatric tympanoplasty type I and analyse the factors suggested to influence the outcome of the said surgery.
A cohort study with control was carried out in 40 patients of chronic suppurative otitis media-mucosal disease in a tertiary care teaching hospital. Patients were divided into two groups of 20 cases each, one comprising of paediatric patients (8-14 years) and other comprising of adult patients (more than 14 years of age). All the patients underwent tympanoplasty type I by post auricular inlay technique. An intact graft at the end of 6th month was considered a success and a minimum hearing improvement of 10 db in two consecutive frequencies was regarded as an audiological success. Results were tabulated and statistically analysed using chi2-test (with Yates correction).
A success rate of 80% in terms of graft uptake and hearing improvement of 61% was seen in paediatric cases, compared to 85% graft uptake and 65% hearing improvement in adult cases. Statistically, on applying chi2-test, the value of P is >0.05 which is insignificant was obtained, indicating that age does not influence paediatric tympanoplasty type I. Also, the data for evaluating the correlation between Eustachian tube and paediatric tympanoplasty type I showed no statistical significance. In addition, no association between site and type of perforation and paediatric tympanoplasty type I was observed when results were compared to adult patients. However, anteriorly placed perforations were found to give poor results in both adult and paediatric group.
The results of this cohort study mitigates against delaying tympanoplasty type I in paediatric population. This study also elucidates that Eustachian tube, contralateral ear pathology, site and type of perforation do not influence the outcome of the said surgery. However, anteriorly placed perforations require vigilance while repair in view of high failure rate. We recommend the age of 8 years for the paediatric tympanoplasty type I, but in view of redundancy of eustachian tube factor, the criteria for delineating minimum age for success of the said surgery is open to debate. More prospective studies are required in this direction.
围绕小儿I型鼓室成形术存在相当大的争议。医学文献中各种已发表的病例系列提出了关于手术时机以及其他各种因素（如咽鼓管、对侧耳状况、穿孔部位和类型等）的相互冲突的观点。然而，很少有前瞻性研究涉及这个问题。因此，计划进行一项前瞻性研究，以评估小儿I型鼓室成形术的成功率，并分析那些被认为会影响该手术结果的因素。
在一家三级护理教学医院对40例慢性化脓性中耳炎 - 黏膜型疾病患者进行了一项有对照的队列研究。患者被分为两组，每组20例，一组为小儿患者（8 - 14岁），另一组为成年患者（14岁以上）。所有患者均通过耳后嵌体技术进行I型鼓室成形术。术后6个月末移植片完整被视为成功，在两个连续频率上听力至少提高10分贝被视为听觉成功。结果列表并使用卡方检验（采用耶茨校正）进行统计学分析。
小儿病例的移植片植入成功率为80%，听力改善率为61%，而成人病例的移植片植入成功率为85%，听力改善率为65%。在进行卡方检验时，P值>0.05，无统计学意义，这表明年龄不影响小儿I型鼓室成形术。此外，评估咽鼓管与小儿I型鼓室成形术之间相关性的数据无统计学意义。另外，将结果与成年患者比较时，未观察到穿孔部位和类型与小儿I型鼓室成形术之间存在关联。然而，发现位于前方的穿孔在成人和小儿组中效果均较差。
这项队列研究的结果不支持在小儿群体中延迟进行I型鼓室成形术。该研究还表明，咽鼓管、对侧耳病变、穿孔部位和类型不影响该手术的结果。然而，鉴于失败率高，在修复位于前方的穿孔时需要格外谨慎。我们建议小儿I型鼓室成形术的年龄为8岁，但鉴于咽鼓管因素的冗余性，界定该手术成功的最低年龄标准仍有待讨论。在这个方向上需要更多的前瞻性研究。
