Bluestone C D, Cantekin E I, Douglas G S
Laryngoscope. 1979 Mar;89(3):450-8. doi: 10.1288/00005537-197903000-00013.
The results of tympanoplastic surgery to repair a perforation of the tympanic membrane are less satisfactory in children than in adults. This paper reports the results of a propspective study of 45 children (51 ears) which was undertaken to determine which, if any, detectable and controllable pre or intraoperative parameters might predict the outcome of tympanoplasty surgery. A "successful" tympanoplasty was defined as that in which the initial graft took, in which the tympanic membrane remained intact, and which was not associated with high negative middle ear pressure, otitis media with effusion, or cholesteatoma during a follow-up period of one to two years. Assessment of hearing related to the tympanoplastic surgery was not included as an outcome measure. With this criteria, the overall success rate of tympanoplasty in children was 35%. The success of tympanoplasty was not related to graft placement, although the laterally placed grafts had a higher take rate (67%) than grafts placed medially (49%). Preoperative measures, such as the assessment of Eustachian tube function using the modified inflation-deflation test and tympanometric evaluation of the contralateral ear, failed to predict the success of tympanoplasty. Tympanoplasty universally failed in the ears in which an acquired cholesteatoma was present. Children remain uncertain candidates for tympanoplasty surgery since, as a group, their Eustachian tube function is not as good as that of adults.
鼓膜成形术修复鼓膜穿孔在儿童中的效果不如在成人中令人满意。本文报告了一项对45名儿童（51只耳朵）进行的前瞻性研究结果，该研究旨在确定是否有任何可检测和可控的术前或术中参数能够预测鼓膜成形术的手术结果。“成功”的鼓膜成形术定义为初次移植成功、鼓膜保持完整且在一到两年的随访期内不伴有中耳高负压、渗出性中耳炎或胆脂瘤。与鼓膜成形术相关的听力评估未作为一项结果指标纳入。按照此标准，儿童鼓膜成形术的总体成功率为35%。鼓膜成形术的成功与否与移植物的放置无关，尽管外侧放置的移植物的成活率（67%）高于内侧放置的移植物（49%）。术前措施，如使用改良的充放气试验评估咽鼓管功能以及对侧耳的鼓室图评估，均未能预测鼓膜成形术的成功。存在后天性胆脂瘤的耳朵，鼓膜成形术普遍失败。由于儿童群体的咽鼓管功能不如成人，他们仍然是鼓膜成形术手术的不确定候选者。
