2017 Sec 1 Green Book

M. Duval

et

al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

336–341

Table 1 Reported

anatomical

success

rate

of

tympanoplasty

in

children

below

8

years

old.

Author

(year)

Age

(years)

Anatomical

success

rate

(%)

Follow-up

Surgical

technique

N

(1983)

[14]

26 14 25 69 21

4–8 2–7 3–8

96 56 64 94 57 83 83

> 1 month > 6mos > 12mos > 6mos > 2 months > 1 month

Temporalis Temporalis Temporalis Unknown Temporalis Temporalis Temporalis Temporalis Temporalis Temporalis Unknown Unknown Temporalis Temporalis Cartilage

fascia, fascia fascia fascia, fascia, fascia fascia

perichondrium

Berger

(1995)

[15]

Black

(1980)

[16]

Buchwach

(1995)

[17]

< 7

Chandrasekhar

(2009)

[18]

4–8

fat,

perichondrium

Charlett Collins

(2003)

[19]

6

< 6

cartilage

(1999) (1980) (2013)

[20]

76

4–8 3–7 4–7 2–6

> 12mos

Denoyelle Friedberg Friedman

[21]

4

100

> 2 months > 1 month

[6]

43 37 20 10 26 11 23

93 81

(1994) (2011)

[22]

> 6mos > 6mos

fascia fascia,

Kessler Knapik

[7]

< 6

100

perichondrium

(1989)

[1]

2–7 2–7

30 92 91 87 84

> 6 months > 3 months

Koch

and

Tos

(1986)

[23]

Lau

(1998)

[24]

< 8

> 6mos > 12mos

fascia fascia

Te

(2003)

[25]

4–8

Umapathy Cumulative

data

411

tympanic membrane was

main

arguments

for

early

repair

of

tympanic membrane

perfora-

determined

by

the

operating

surgeon

in

children

include

improved

hearing

for

optimization

of

follow-up

visits

using

otoscopy

and/or

micro-otoscopy.

A

tion

at

and and

language

development,

prevention

of

chronic

ear

persistent noted within 6 months post-operatively and a recurrent perforation was defined as any perforation noted more than 6 months post-operatively. Secondary outcomes evaluated included post-operative tympanic membrane or middle ear cholesteatoma, need for tympanostomy tube and audiologic responses (ABG and SRT). perforation was defined as a perforation

speech disease

allowing

children

to

enjoy water

activities.

2. Objective

objective

of

this

study was

to

evaluate

the

success

rate

of as

The

tympanoplasty

performed

in

pre-school

children

primary

Analysis

3.2.

to

that of older

children. The primary outcome measure

compared

the

status of

the

tympanic membrane

at

the

end of

evaluated was

Data analysis was performed using Stata version 12. Chi-square test was used to analyze categorical data and t -test was used to analyze continuous data. A p -value less than 0.05 was considered significant on crude analysis for possible inclusion of the variable into the multivariate analysis. A paired t -test was used to evaluate the difference between pre-operative and post-operative hearing results. An analysis of variance (ANOVA) was used to determine whether hearing results were statistically different between the three different age groups. A logistic regression was performed to evaluate the association between age group and post- tympanoplasty perforation as well as determine which factors were associated with anatomical success. A subgroup logistic regression analysis was also performed including only children with 6 months or more of follow-up.

period

of

follow-up.

Secondary

outcome measures

evaluated

the

for

tympanostomy

tubes, cholesteatoma

formation and

were need

in

hearing

thresholds.

improvement

3. Methods

A

retrospective

review

of

children

13

years

old

or

younger

undergone

a

primary

tympanoplasty

between

2002

and

having

at

a

tertiary

care

pediatric

hospital

by

four

pediatric University board was

2013

was

performed.

Approval

from

the

otolaryngologists

and

Primary

Children’s Hospital

ethics

review

of Utah

Four

surgeons

performed

all

tympanoplasties

included Surgical

obtained.

this

study

and

all

worked

regularly

with

residents.

in

approach Exclusion

and

graft

material

varied

between

the

technique, surgeons.

criteria

included

revision

tympanoplasty,

4. Results

concomitant

or

previous

ipsilateral mastoidecto-

cholesteatoma,

concomitant ossiculoplasty,

concomitant

tympanostomy

tube

my,

and

tympanic

membrane

retraction

pocket

without

a

total of 284

tympanoplasties

in 259

children were performed

insertion

A

included age at

time of

surgery, gender,

2002

and

2013

by

four

pediatric

otolaryngologists.

The 106

perforation. Data collected

between median

of

perforation,

status

of

the

contralateral

ear,

prior graft

follow-up

duration

was

7.5

months

(range

1

to

etiology

characteristics

of

the

perforation,

type

of

children had 6 or more months of

adenoidectomy,

months). One hundred fifty-five

surgical

technique,

complications and duration of

follow-up.

used,

follow-up.

results

were

evaluated

by

reviewing

pre- and

and

post-

of

patient’s

and

surgical

characteristics

is

pre-

Hearing operative

Distribution

speech

reception

thresholds

(SRT)

pure-tone

in

Table

2 .

The

overall

incidence

of

intact

tympanic

sented

(ABG). Air-bone gap was calculated according

for

the whole duration

of

follow-up was

72.5%

overall

average air-bone gap

membrane

the

American

Academy published performed

of

Otolaryngology—Head

and

Neck

63.2%

in

patients

with

at

least

6 months

of

follow-up.

The

to

and

guidelines

in

1995

[26] .

Post-operative

audio-

intact

tympanic membrane by age group was 69.4%

Surgery

incidence of an

usually

at

6

to

12 weeks

post-operatively.

in children age 5–7 and 79.1%

in children

gram was

in children age 2–4, 68.5% age 8–13. There was no

Patients were old, 5–7 years old and 8–13 years old. These age groups were designed to compare the outcome in pre-school children to those older than 8 years of age. separated into 3 age categories: 2–4 years

statistically

significant evidence of a

linear

between

rate

of

perforation

post-tympanoplasty

and

association

(OR = 0.91,

95%

CI

0.82–1.01).

Mean

prevalence

of

intact

age

at

the

end

of

the

follow-up

period

by

age

is

tympanic membrane

in

Fig.

1.

On

crude

analysis,

factors

that

were

most

presented

associated

with

increased

odds

of

post-tympanoplasty

strongly

Outcome

3.1.

were

use

of

acellular

dermis

( p = 0.004),

transcanal

perforation approach association

satisfactory

outcome

was

defined

as

an

intact

tympanic

( p < 0.001)

and

surgeon

( p = 0.004).

There

was

no

A

at

the

end

of

the

follow-up

period.

Status

of

the

membrane

between

post-tympanoplasty

perforation

and

season

120