Primary and revision myringoplasty in children: Long-term outcome and analysis of the factors influencing the results.

OBJECTIVE

Assess the long-term outcome of pediatric myringoplasty.

METHODS

Tympanoplasty type I, myringoplasty, was performed on 85 children (91 consecutive operations, 74 primary and 17 revisions) under 16 years of age. The perforations were sequela either to acute or chronic inflammatory middle ear disease. Medial grafting technique was employed with temporalis fascia. Adenoidectomy was performed earlier on all but five children. The preoperative observation period exceeded one year for all patients. The mean follow-up was 5.4 (SD 3.6) years.

RESULTS

The long-term graft take rate was 84% for primary myringoplasty, and 53% for revision operations. The re-perforations were associated with postoperative discharge, subtotal or total perforation and revision surgery. In the cohort, sixty ears (66%) were completely healthy (intact tympanic membrane in normal position without adhesions and with good mobility) after follow-up. Spontaneous healing took place in 37% after re-perforation. The preoperative ventilation tube treatment did not affect the outcome and there were no differences between age groups. Preoperative sonotubometry or Valsalva test results did not correlate with outcome. Four ears needed a ventilation tube during the follow-up due to poor ventilation. The mean pure tone thresholds improved significantly after operation.

CONCLUSIONS

Myringoplasty in children is a reliable procedure without age restrictions. One year of preoperative observation excludes most unstable ears, and high tendency of spontaneous healing after re-perforation suggests the need for a lengthy follow-up before revision surgery.