Fasciaform myringoplasty in children.

OBJECTIVE

To evaluate the efficacy of fasciaform myringoplasty as a means to repair large tympanic membrane perforations in children.

DESIGN

Retrospective review of the records of 26 patients who underwent 29 consecutive fasciaform myringoplasty surgeries over a 47-month period. Patients were followed up from 2 to 47 months postoperatively.

SETTING

Academic tertiary care children's hospital.

PARTICIPANTS

Twenty-six patients (5 to 16 years old), with tympanic membrane perforations (25% to 95%) underwent a fasciaform myringoplasty procedure. The perforations were caused by extrusion of ventilation tubes (83%), deep retraction pockets, trauma, or repair after resection of cholesteatoma.

INTERVENTION

The surgery involves resection of the native tympanic membrane and annulus. A new tympanic membrane is formed from formaldehyde-fixed autogenous temporalis fascia and positioned.

OUTCOME MEASURE

Successful repairs, complications, and audiometric evaluations were analyzed. Fisher's Exact Test was used to compare complication rates by age.

RESULTS

Successful closure was accomplished in 69% of cases. Otitis media recurred in 52%. Ventilation tubes were reinserted in 24%; 28% resolved with antibiotics alone. When tubes were placed through the graft, small residual graft perforations resulted. Audiometric evaluation revealed improvement in pure tone average to less than a 20-dB hearing level in 77% and reduction of the air-bone gap to within a 20-dB hearing level in 90% of those cases (10/29) with complete audiometric data.

CONCLUSIONS

Fasciaform myringoplasty has proven to be a successful procedure for closing large tympanic defects and improving hearing acuity in the pediatric population. However, recurrent otitis media and eustachian tube dysfunction may continue. Rates of reperforation were statistically significantly higher in children 7 years old and younger. Conservative management of children in this younger age group is warranted.