143 / 232
(
p
= 0.35),
number
of
previous
tympanostomy
tubes
(
p
= 0.82),
otorrhea
in
the
6
months
prior
to
surgery
(
p
= 0.27),
previous
adenoidectomy
(
p
= 0.68)
or
previous
myringoplasty
(
p
= 0.77).
Pre-school
children
were
more
likely
to
have
a
contralateral
perforation
(
p
= 0.02).
There
was
a
total
of
69
children
with
craniofacial
disorders
including
36
children
with
cleft
palate,
24
children
with
Down
syndrome
and
9
children with
other
craniofacial
disorders
such
a
craniosynostosis.
The
anatomical
success
rate
in
children
with
craniofacial
disorders was
between
70.8%
and
88.9%
and was
not
statistically
different
between
the
different
subtypes
of
craniofa-
cial
disorders
or
compared
to
children without
any
craniofacial
disorder. While
children with
craniofacial
abnormalities
did
not
have
a
decreased
anatomical
success
rate,
they were
significantly
more
likely
to
develop
serous
otitis
media
and/or
require
tympanostomy
tubes
after
tympanoplasty
(
p
= 0.02).
The
number
of
children
with
other
relevant
comorbidities
such
as
chronic
sinusitis
(1),
environmental
allergies
(1)
or
asthma
(1)
was
not
sufficient
in
order
to
perform
a
subgroup
analysis.
Results
of
the
crude
analysis with
odds
ratio
of
the
different
complications
evaluated
per
age
group
and
their
associated
odds
ratio
is presented
in
Table 3
. There were no
significant differences
in
the
rate
of
any
of
the
complications
evaluated
for
the
different
age
groups.
There were
78
anatomical
failures with
a
perforation
noted
at
the end of
the
follow-up period of which 16
(20.5%) were
recurrent
perforations noted
after more
than
6 months
of
follow-
up and 62
(79.5%) were persistent perforations. Of
the 78 recurrent
or persistent perforations, 20 were pinpoint
(25.6%), 42 were
<
50%
and
2
were
>
50%
of
the
tympanic
membrane
area.
17.9%
of
perforations
were
the
same
size,
55.1%
were
smaller,
7.7%
were
larger
and
19.2% were
of
unknown
size.
The
two
residual
perforations
>
50% had been
<
50% at
the
initial
surgery. Seventeen
children
(6.0%)
underwent
a
tympanostomy
tube
insertion
post-
tympanoplasty
and
17
children
(6.4%)
developed
a
tympanic
membrane
cholesteatoma pearl
(12) or middle
ear
cholesteatoma
(5).
Fifty-six
children
underwent
revision
surgery
for
tympanic
membrane
perforation
(42)
or
cholesteatoma
(14).
Five
children
undergoing
revision surgery
for a
tympanic membrane perforation
underwent a concomitant mastoidectomy due
to chronic otorrhea.
First
revision
tympanoplasty
for
tympanic membrane
perforation
was
successful
in
20/37
(54.1%)
children,
unsuccessful
in
14/37
(37.8%)
children
and was
unknown
in
3/37
(8.1%)
children.
Hearing
results
are
shown
in
Tables
4
and
5
.
All
age
groups
had
significant
improvement
in
their
hearing
thresholds
post-
tympanoplasty
and
the
hearing
thresholds were
not
significantly
different between
the
three
age
groups. Children with
an
ongoing
perforation
after
the
initial
tympanoplasty
had
poorer
hearing
outcomes
than children with a successful tympanoplasty and had a
post-operative
SRT
of
21.0 dB
(
p
= 0.25)
and
a post-operative ABG
of
13.5 dB
(
p
= 0.02).
Logistic
regression
analysis
revealed
that
covariates modifying
the
association
between
perforation
post-tympanoplasty
and
age
group
were
surgeon,
surgical
approach
(transcanal
vs
postauricular)
and
etiology
of
perforation.
Results may
be
found
in
Table
6
. Multivariate
analysis
revealed
that
after
adjusting
for
confounders
there
is
a
significant difference between
the perfora-
tion
rate
post-tympanoplasty
in
preschool
children
(age
2–4)
(
p
= 0.04)
and
children
age
5–7
years
old
(
p
= 0.03)
compared
to
Table
2
Patient and surgical characteristics per status of
the
tympanic membrane at
the end
of
the
follow-up
period.
Characteristic
No
perforation
n
= 206,
n
(%)
Perforation
n
= 78,
n
(%)
OR,
(
p
-value)
Age
group
(0.16)
2–4
34
(69.4)
15
(30.6)
1.66
(0.19)
5–7
89
(68.5)
41
(31.5)
1.74,
(0.07)
8–13
83
(79.0)
22
(21.0)
1.0
Gender
Male
111
(73.5)
40
(26.5)
0.89,
(0.67)
Female
95
(71.4)
38
(28.6)
Adenoidectomy
Yes
98
(73.7)
35
(26.3)
0.89,
(0.68)
No
107
(71.3)
43
(28.7)
Craniofacial
anomaly
Yes
54
(79.4)
14
(20.6)
0.62,
(0.15)
No
151
(70.2)
64
(29.8)
Contralateral
perforation
Yes
53
(70.7)
22
(29.3)
1.14,
(0.66)
No
153
(73.2)
56
(26.8)
Middle
ear
inflammation
Yes
16
(88.9)
2
(11.1)
0.31,
(0.13)
No
188
(71.2)
76
(28.8)
Etiology
(0.04)
Tubes
167
(70.2)
71
(29.8)
1.0
Chronic
ear
disease
17
(89.5)
2
(10.5)
0.28,
(0.09)
Trauma
9
(90.0)
1
(10.0)
0.26,
(0.21)
Surgeon
(0.005)
1
88
(84.6)
16
(15.4)
1.0,
2
70
(67.3)
34
(32.7)
2.67,
(0.004)
3
40
(64.5)
22
(35.5)
3.03,
(0.004)
4
8
(57.1)
6
(42.9)
4.13,
(0.02)
Approach
Transcanal
98
(64.1)
55
(35.9)
2.64,
(
<
0.001)
Post-auricular
108
(82.4)
23
(17.6)
Technique
Overlay
24
(96.0)
1
(4.0)
0.10,
(0.02)
Underlay
182
(70.3)
77
(29.7)
Material
(0.01)
Temporalis
fascia
118
(79.2)
31
(20.8)
1.0
Perichondrium
25
(69.4)
11
(30.6)
1.67,
(0.21)
Acellular
dermis
51
(60.0)
34
(40.0)
2.54,
(0.002)
Cartilage
11
(84.6)
2
(15.4)
0.69,
(0.64)
Size
>
50%
32
(64.0)
18
(36.0)
1.60,
(0.16)
<
50%
159
(74.0)
56
(26.0)
Location
(0.39)
Anterior
86
(71.7)
34
(28.3)
1.0
Posterior
52
(70.3)
22
(29.7)
1.07,
(0.84)
Central
30
(85.7)
5
(14.3)
0.42,
(0.10)
Fig. 1.
Prevalence of
intact
tympanic membrane at
the
end of
the
follow-up period
per
age.
M. Duval
et al.
/
International
Journal
of
Pediatric Otorhinolaryngology
79
(2015)
336–341
121