Silvola Juha T, Sinkkonen Saku T
Department of Otorhinolaryngology, Akershus University Hospital, and Campus Ahus, University of Oslo, Norway.
Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
J Otol. 2024 Apr;19(2):85-90. doi: 10.1016/j.joto.2024.04.001. Epub 2024 Oct 19.
Assess the long-term outcome of pediatric myringoplasty.
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.
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.
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.
评估小儿鼓膜成形术的长期疗效。
对85名16岁以下儿童（共进行91次手术，其中74例初次手术，17例翻修手术）实施I型鼓室成形术（即鼓膜成形术）。穿孔是急性或慢性炎性中耳疾病的后遗症。采用颞肌筋膜进行内侧植皮技术。除5名儿童外，所有儿童均较早进行了腺样体切除术。所有患者术前观察期均超过1年。平均随访时间为5.4（标准差3.6）年。
初次鼓膜成形术的长期植皮成功率为84%，翻修手术的成功率为53%。再次穿孔与术后流脓、部分或完全穿孔以及翻修手术有关。在该队列中，随访后60只耳朵（66%）完全健康（鼓膜完整，位置正常，无粘连，活动良好）。再次穿孔后37%实现了自愈。术前置管治疗不影响疗效，各年龄组之间无差异。术前声导抗测听或瓦尔萨尔瓦试验结果与疗效无关。随访期间有4只耳朵因通气不良需要置管。术后平均纯音听阈显著改善。
小儿鼓膜成形术是一种可靠的手术，无年龄限制。一年的术前观察可排除大多数不稳定的耳朵，再次穿孔后较高的自愈倾向表明在翻修手术前需要进行长期随访。
