2017 Sec 1 Green Book

M. Duval

et al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

336–341

Table 6 Adjusted odds

ratio of association between perforation and age group by

logistic

regression after controlling

for confounding effect of surgeon, surgical approach and etiology

perforation.

of

Adjusted OR

Variable

Level

Adjusted OR

of

perforation

of

perforation

(95%CI)

n =267

follow-up > 6mos

OR

if

OR

(95%CI)

n = 146

group

2–4 5–7

years years

old old

2.46 2.06

(1.04–5.85) (1.06–4.00)

5.48 2.27

(1.68–17.93) (0.94–5.46)

Age

years

old

1.0

1.0

8–13

Surgeon

1 2 3 4

1.0

1.0

1.62 3.48 3.66

(0.71–3.73) (1.49–8.11) (0.95–14.15)

1.16 5.07 3.12

(0.40–3.33) (1.64–15.62) (0.61–15.80)

Approach

Post-auricular

1.0

1.0

(1.15–4.90)

2.76

(1.07–7.09)

Trans-canal

2.37

Etiology

Tympanostomy

tubes

1.0

1.0

Chronic Trauma

otitis media

0.32 0.25

(0.06––1.56) (0.03–2.16)

0.13 0.57

(0.01–1.47) (0.05–6.30)

surgeons

to

trainees

[15,28]

but

no

study

has

previously

Strengths

and weaknesses

5.1.

specifically

success

rate

of

tympanoplasty

in

estab-

investigated

surgeons. While

the

surgeons’

choices of

surgical

approach, individual

strength

of

this

study

is

the

large

number

of

pre-

lished

The major

influenced

their

included addition,

in

the analysis as well as

the

large size

technique and graft material may have

school age children

rate,

this

study

was

not

powered

to

detect

factors

to

our

cohort.

In

these

results

represent

a

‘‘real

life’’

success explain

of

individual

surgeon’s

success

rate.

with

children

with

and

without

comorbidities

having surgical

situation

there appeared

to be a

strong association between use of

surgery Finally,

by multiple

surgeons

using

different

While

undergone techniques. multivariate

dermis

and

success acellular

rate,

the

association

between

graft

this

is

one

of

few

studies

having factors

performed associated

acellular material,

specifically

dermis,

and

success

rate was

not

analysis

in

order

to

determine

the

on multivariate

analysis.

This may

have

been

due

to

failure

of

pediatric

tympanoplasty.

maintained

with

fact

that

the

association

may

have

been

explained

by

the this

important weakness of

this study

is

the short duration

the

The most follow-up.

identity, as

surgeons 2 and 3 were

the main users of

One

hundred

twenty-nine

children

had

less

than

surgeon’s material.

of

It may also be due

to a

lack of power due

to

the small size

of

follow-up

and

the median duration

of

follow-up was

6 months

of the study. Given some of

the advantages of acellular dermis such

7

months.

This

is

partially

attributed

to

the

fact

that

the

only

avoidance

of

a

post-auricular

incision

in

trans-canal

tympano- acellular pediatric

in a

tertiary care children may

institution with

as

tympanoplasties were performed

further

research

is

needed

to

determine whether

large

referral

base

and

that

some

have

had

post-

plasty, dermis

a

is

a

acceptable

graft

material

alternative

for

care performed by an otolaryngologist

closer

to home.

It

operative is possible up had been

that

the results obtained would have differed if

follow-

tympanoplasty. Other factors

that

have

been

previously

evaluated

for

their

longer. The differences

in results between all children

association

with

pediatric

tympanoplasty

success

rate

children with 6

or more months

of

follow-up

could be due

to

possible

and the first

evaluated

as

part

of

our

study. On multivariate

analysis,

in

fact

that

children with

an

intact

tympanic membrane

at

the

were

to

surgeon,

surgical

approach

and

etiology of perforation

follow-up

visit

may

be

less

likely

to

return

for

follow-up.

addition

found

to

be

associated with

success

rate

of

tympanoplasty.

it

is

possible

that

children

who

did

not

have

a a

were

Conversely, minimum

only

study having directly

evaluated

the

success

rate

of post-

of

6

months

of

follow-up

may

have

developed

The

compared

to

trans-canal

tympanoplasty

in

children had

or

residual

perforation

that went

undiagnosed

due

to

auricular

recurrent

found

any

difference

in

the

success

rate

between

the

two

failure

to

return

for

a

follow-up

visit

thus

lowering

the

not

their

[2] . However,

given

the

narrower

ear

canal

in

young

or

persistent

perforation

rate when

including

children

approaches children, providing

recurrent

the

post-auricular

approach

could

be

advantageous

in

less

than

6 months

of

follow-up

in

the

current

analysis.

with

better

exposure

to

the

tympanic membrane

and

thus

6. Conclusion

to

better

success

rate. With

the

increased use

of

the

otologic

lead

increased exposure associated with

this

technique,

endoscope and

would

be

interesting

to

evaluate

whether

this

will

lead

to

a

is

the

first

study

evaluating

the

success

rate

of

it

This

rate

of

perforation

post-tympanoplasty

in

transcanal

in of

pre-school

children

and

the

study

with

the for

decrease

tympanoplasty

number

children

under

6

years

old.

After

adjusting

tympanoplasties. In summary,

largest

the otolaryngologist

should notify

the

caregivers

pre-school

children

appear

to

have

a

significantly

confounders,

the

pros

and

cons

of

early

repair

and

inform

the

parents

of

odd

of

perforation

post-tympanoplasty. While it

remains life and tympa-

of

higher

potential

for

an

unsuccessful

outcome

in

younger

children include

the possible in hearing

improvement

in quality of

the

uncertain whether

tympanoplasty.

Advantages

of

early

repair

improvement

thresholds

associated with

undergoing prevention

small

of

complications

such

as

potential

reduction

of to

outweighs

the

risk

of

tympanoplasty tympanoplasty

failure

in

young

noplasty children,

otitis

media,

improved

hearing

and

the

ability

the 26%

rate of

revision

in children age 2–

chronic

in water activities. Disadvantages

include a potential-

years

old

suggest

that

surgery may

be

best

delayed

in

that

age

participate

4

more

technically

difficult

surgical

procedure

due

to

the

ly

group.

size

of

the

external

auditory

canal

and

higher

failure

studies

with

a

longer

follow-up

period,

large

smaller

Prospective

for a

revision procedure or

tympanostomy

size

and key

quality

of

life measures

are

needed

to

elucidate studies.

rate and possible need

sample

tubes.

of

the

questions

generated

from

this

and

prior

some

123