Pediatric tympanoplasty of iatrogenic perforations from ventilation tube therapy.

OBJECTIVES

This study aimed to determine surgical outcome of tympanoplasty in children with iatrogenic perforations, to determine whether age is a factor in successful tympanoplasty, and to determine whether surgical outcome is affected by preoperative factors (e.g., perforation size and location, otorrhea, cholesteatoma, and tympanosclerosis) or surgical technique (e.g., underlay or overlay).

STUDY DESIGN

The study design was a retrospective series review.

SETTING

The study was conducted at a multiphysician private otologic practice.

PATIENTS

Ninety-three pediatric patients with iatrogenic perforations caused by the insertion of ventilation tubes for otitis media with effusion (OME) participated. Surgical selection criteria included a year's observation of the perforation with a 6-month OME-free interval in the involved and contralateral ear. The 46 males and 47 females had a mean age at surgery of 10.8 years (standard deviation = 2.9) ranging from 3-16 years.

INTERVENTIONS

All patients underwent underlay or overlay tympanoplasty using temporalis fascia grafts.

MAIN OUTCOME MEASURES

Outcome was evaluated in terms of drum healing (healed or perforated), hearing (air-bone gap), and complications.

RESULTS

There was a graft take-rate of 94.6% with reperforations occurring in 5.4% with an average follow-up of 16.8 months. Duration of follow-up ranged from 10.8-77.5 months. The air-bone gap was completely closed in 53.8% and was closed to within 10 dB in 80.7% and 20 dB in 94.7%. The incidence of major and minor complications was 16.1%. Surgical outcome was not influenced by age, technique, or any of the preoperative factors.

CONCLUSIONS

Tympanoplasty of persistent perforations after ventilation tube therapy for recurrent OME can be performed successfully regardless of age, surgical technique, or other preoperative factors.