Our Summary

This study looks at the best timing and method for repairing chronic eardrum perforations in children. Researchers reviewed cases from a teaching hospital where one surgeon performed this type of surgery over four years. They looked at how successful the surgery was and what impact it had on the child’s hearing.

Out of 78 cases, the average age of the child at the time of surgery was 10.3 years. Most of the children didn’t have any other health conditions, but a majority had a history of issues with their Eustachian tubes (the tubes that connect the middle ear to the back of the throat) and severe myringosclerosis (a condition that causes the eardrum to harden).

About one-third of the surgeries were re-do surgeries. A surgeon in training was present in almost 90% of the surgeries. The surgery was successful in closing the eardrum in 97.4% of the cases, and in 92.6% of cases where the child was followed up with for more than a year.

The researchers found that factors such as the child’s age at the time of surgery, the size of the perforation, history of Eustachian tube problems, presence of a surgeon in training, myringosclerosis, presence of other health conditions, or a history of previous eardrum surgery didn’t seem to make a difference in whether the surgery was successful or not.

In 91% of the patients, their hearing either got better or stayed the same after the surgery. The only thing that seemed to be linked with worse hearing outcomes was a complication that occurred after the surgery called blunting.

The conclusion is that this type of surgery is a good way to repair chronic eardrum perforations in children and it often results in good hearing outcomes.

FAQs

  1. What is the success rate of pediatric lateral graft tympanoplasty in repairing chronic tympanic membrane perforations?
  2. What factors were found to not be associated with graft failure in pediatric lateral graft tympanoplasty?
  3. What were the primary and secondary outcomes of the review of pediatric lateral graft tympanoplasties performed for chronic tympanic membrane perforations?

Doctor’s Tip

One helpful tip a doctor might give a patient about tympanoplasty is to follow post-operative care instructions carefully, including keeping the ear dry and avoiding activities that could put pressure on the repaired eardrum. This can help ensure successful healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended for tympanoplasty are those with chronic tympanic membrane perforations, especially in pediatric patients. In this study, the patients who underwent lateral graft tympanoplasty had a mean age of 10.3 years and presented with marked myringosclerosis. Many of these patients had a history of bilateral Eustachian tube dysfunction and some had undergone previous tympanoplasties. Overall, the surgical outcomes were successful with a high rate of graft closure and excellent hearing outcomes. Age at the time of surgery, perforation size, presence of Eustachian tube dysfunction, and history of prior tympanoplasty did not significantly impact the success of the procedure.

Timeline

  • Before tympanoplasty:
  1. Patient presents with chronic tympanic membrane perforation.
  2. Patient may have a history of bilateral Eustachian tube dysfunction and marked myringosclerosis.
  3. Patient undergoes evaluation by an ENT specialist.
  4. Surgical decision is made to proceed with tympanoplasty.
  5. Patient undergoes pre-operative assessments and preparation for surgery.
  • After tympanoplasty:
  1. Tympanoplasty surgery is performed to repair the perforated tympanic membrane.
  2. Patient is monitored post-operatively for any complications or signs of graft failure.
  3. Patient may experience temporary hearing loss or discomfort post-operatively.
  4. Patient follows post-operative care instructions, including keeping the ear dry and avoiding activities that may increase pressure in the ear.
  5. Follow-up appointments are scheduled to monitor healing and hearing outcomes.
  6. Patient may experience improved hearing or preservation of their conductive hearing deficit.
  7. Successful closure of the tympanic membrane is achieved in the majority of cases.
  8. Hearing outcomes are generally excellent, with only a small percentage experiencing poorer outcomes associated with post-operative blunting.

What to Ask Your Doctor

  1. What is the success rate of tympanoplasty in pediatric patients?
  2. How long is the recovery process after tympanoplasty?
  3. What are the potential risks or complications associated with tympanoplasty?
  4. Will my child experience any pain or discomfort during or after the procedure?
  5. How soon after the surgery will my child be able to return to normal activities, such as school or sports?
  6. Will my child’s hearing improve after tympanoplasty?
  7. Are there any specific precautions or restrictions my child should follow post-surgery?
  8. How often will follow-up appointments be needed after tympanoplasty?
  9. Are there any alternative treatment options for chronic tympanic membrane perforations in pediatric patients?
  10. What experience does the surgeon have with performing tympanoplasty on pediatric patients?

Reference

Authors: Zhan KY, Rawlins KW, Mattingly JK, Malhotra PS, Adunka OF. Journal: Int J Pediatr Otorhinolaryngol. 2019 Apr;119:166-170. doi: 10.1016/j.ijporl.2019.01.038. Epub 2019 Jan 28. PMID: 30711838