Knapik Monika, Saliba Issam
Sainte-Justine University Hospital Center, 3175, Côte Sainte-Catherine, Department of Pediatric Otorhinolaryngology, Montreal (Qc) H3T 1C5, Canada.
Int J Pediatr Otorhinolaryngol. 2011 Jun;75(6):818-23. doi: 10.1016/j.ijporl.2011.03.015. Epub 2011 Apr 9.
To analyze the success rates of myringoplasty in children, to assess prognostic factors and to evaluate their interactions in the evolution of myringoplasty.
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.
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.
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.
分析儿童鼓膜成形术的成功率，评估预后因素，并评估它们在鼓膜成形术进展过程中的相互作用。
回顾了1997年至2007年间接受鼓膜成形术患者的病历，内容包括：患者年龄、性别、穿孔侧、病因、穿孔大小、类型和位置、手术季节、鼓膜成形术类型、手术技术、移植材料、患侧耳和对侧耳的术前状况、患侧耳和/或对侧耳的耳科手术史、患侧耳和对侧耳之前手术的次数、最后一次耳科手术与此次鼓膜成形术之间的时间间隔、腺样体切除术或扁桃体切除术史、腺样体切除术或扁桃体切除术与此次鼓膜成形术之间的时间间隔。解剖学成功定义为术后鼓膜完整。听力学成功定义为气骨导差小于20 dB，且术后平均骨导阈值差异不超过10 dB。
1997年至2007年间共进行了201例鼓膜成形术。6个月、12个月和24个月时的解剖学成功率分别为94.9%、84.9%和70.1%。发现患侧耳之前的耳科手术类型对解剖学成功具有统计学意义。6个月、12个月和24个月时分别有97.4%、93.4%和84.9%的患者获得听力学成功。术后气骨导差平均降低9.1 dB。未发生感音神经性听力损失。与年龄较小的儿童相比，12岁及以上儿童在≥2000 Hz频率时术前骨导在统计学上较差。这些结果表明，鼓膜穿孔的慢性化可导致内耳长期不可逆损伤。
发现患侧耳之前的耳科手术类型对解剖学成功有影响。当之前手术的病因是良性时，鼓膜成形术的结果更有利。我们提倡早期鼓膜成形术，最好在6岁以上。延迟手术会导致内耳永久性损伤。评估的所有其他因素对解剖学或听力学成功均无统计学意义。
