Department of Otolaryngology- Head and Neck Surgery, Belgium.
Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
Int J Pediatr Otorhinolaryngol. 2022 Feb;153:110990. doi: 10.1016/j.ijporl.2021.110990. Epub 2021 Nov 24.
Until today, there is no consensus about the ideal age for a myringoplasty in children. In this retrospective study, we study our own series to characterize different prognostic factors to answer questions/dilemmas such as when to carry out surgery in a child with an ear drum perforation, when to postpone surgery or when to use a different technique to improve the outcome after tympanoplasty.
We performed a retrospective study on charts of 97 children who underwent a myringoplasty. The same surgeon (IF) treated all included children and with the same classical surgical technique: retro-auricular approach and microscopic underlay placement of fascia of the musculus temporalis. Children with associated disease (cholesteatoma, revision surgery and ossicular chain defects) were excluded. All children had a minimum follow up of 12 months. A successful procedure was defined as a closed eardrum after 12 months and an air bone gap <20 dB. Prognostic factors were inventoried and studied.
Success rate after myringoplasty is 80.2% in this pediatric case series. Age was not a statistical significant prognostic factor. Only the history of an adenoidectomy had a positive effect on tympanic closure (p = 0.047). A negative prognostic factor was the size of the perforation: large perforations showed only 42.9% eardrum closure (p = 0.040). There was a complication rate of 28.9%, in which formation of granulation tissue and ear discharge were most common but easily treated.
Tympanoplasty type 1 with musculus temporalis fascia in underlay is a safe and successful technique in children of all ages with eardrum perforations. Our data suggests using a different technique (cartilage tympanoplasty) in cases with large perforation. Postponing surgery is not advocated, unless perhaps in children with poor Eustachian function or adenoidhyperplasia.
时至今日，对于儿童鼓膜成形术的理想年龄仍无定论。在这项回顾性研究中，我们研究了自己的系列病例，以确定不同的预后因素，从而回答一些问题/困境，例如对于鼓膜穿孔的儿童何时进行手术，何时推迟手术，或何时采用不同的技术以提高鼓室成形术后的效果。
我们对 97 例行鼓膜成形术的儿童的病历进行了回顾性研究。同一位外科医生（IF）治疗了所有纳入的儿童，采用相同的经典手术技术：耳后入路和显微镜下颞肌筋膜的黏膜下放置。排除了伴有其他疾病（胆脂瘤、翻修手术和听小骨链缺损）的儿童。所有儿童的随访时间均至少为 12 个月。成功的手术定义为术后 12 个月鼓膜封闭，气骨导差<20dB。对预后因素进行了盘点和研究。
在这个儿科病例系列中，鼓膜成形术后的成功率为 80.2%。年龄不是一个统计学上显著的预后因素。只有腺样体切除术的病史对鼓膜封闭有积极影响（p=0.047）。穿孔的大小是一个负面的预后因素：大穿孔的鼓膜封闭率仅为 42.9%（p=0.040）。并发症发生率为 28.9%，其中最常见的并发症是肉芽组织形成和耳漏，但容易治疗。
对于所有年龄段的鼓膜穿孔儿童，使用颞肌筋膜的 1 型鼓室成形术是一种安全且成功的技术。对于大穿孔的病例，我们建议使用不同的技术（软骨鼓膜成形术）。除非儿童存在咽鼓管功能不良或腺样体增生，否则不建议推迟手术。
