2017 Sec 1 Green Book

et al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

336–341

M. Duval

Table 2 Patient and surgical characteristics per status of the

tympanic membrane at

the end

the

follow-up

period.

of

Perforation n = 78, n (%)

OR, ( p -value)

Characteristic

No

perforation

n = 206,

(%)

n

group

Age 2–4 5–7

(0.16)

(69.4) (68.5) (79.0)

15 41 22

(30.6) (31.5) (21.0)

1.66 1.74,

(0.19) (0.07)

34 89 83

1.0

8–13

Gender Male Female

111

(73.5) (71.4)

40 38

(26.5) (28.6)

0.89,

(0.67)

95

Adenoidectomy Yes

(73.7) (71.3)

35 43

(26.3) (28.7)

0.89,

(0.68)

98

No

107

Craniofacial

anomaly

(79.4) (70.2)

14 64

(20.6) (29.8)

0.62,

(0.15)

Yes

54

No

151

Fig. 1. Prevalence of

intact

tympanic membrane at

the

end of

the

follow-up period

Contralateral

perforation

age.

per

(70.7) (73.2)

22 56

(29.3) (26.8)

1.14,

(0.66)

Yes

53

No

153

Middle

ear

inflammation

more

likely

to

develop

serous

otitis

media

and/or

require number chronic

Yes

16

(88.9) (71.2)

2

(11.1) (28.8)

0.31,

(0.13)

tubes

after

tympanoplasty

( p = 0.02).

The

tympanostomy

76

No

188

Etiology

(0.04)

children

with

other

relevant

comorbidities

such

as

of

(70.2) (89.5) (90.0)

71

(29.8) (10.5) (10.0)

1.0

Tubes

167

(1),

environmental

allergies

(1)

or

asthma

(1)

was

not

sinusitis sufficient

ear

disease

17

2 1

0.28, 0.26,

(0.09) (0.21)

Chronic Trauma

in

order

to

perform

a

subgroup

analysis.

9

of

the

crude

analysis with

odds

ratio their

of

the

different

Results

Surgeon

(0.005)

evaluated

per

age

group

and

associated

odds

complications

1 2 3 4

88 70 40

(84.6) (67.3) (64.5) (57.1)

16 34 22

(15.4) (32.7) (35.5) (42.9)

1.0,

is presented

in Table 3 . There were no

significant differences

ratio

2.67, 3.03, 4.13,

(0.004) (0.004)

the

rate

of

any

of

the

complications

evaluated

for

the

different

in

groups.

There were

78

anatomical

failures with

a perforation (20.5%) were

age

8

6

(0.02)

at

the end of

the

follow-up period of which 16

noted

Approach Transcanal

perforations noted

after more

than

6 months

of

follow-

recurrent up and 62

(64.1) (82.4)

55 23

(35.9) (17.6)

2.64,

( < 0.001)

98

(79.5%) were persistent perforations. Of

the 78 recurrent

Post-auricular

108

(25.6%), 42 were < 50%

or persistent perforations, 20 were pinpoint

2

were

> 50% were

of

the

tympanic

membrane

area.

17.9%

of

and

Technique Overlay Underlay

the

same

size,

55.1%

were

smaller,

7.7%

perforations

(96.0) (70.3)

1

(4.0)

0.10,

(0.02)

24

77

(29.7)

182

larger

and

19.2% were

of

unknown

size.

The

two

residual

were

perforations > 50% had been < 50% at

the

initial

surgery. Seventeen

Material

(0.01)

(6.0%)

underwent

a

tympanostomy

tube

insertion

post-

children

fascia

118

(79.2) (69.4) (60.0) (84.6)

31 11 34

(20.8) (30.6) (40.0) (15.4)

1.0

Temporalis

and

17

children

(6.4%)

developed

a

tympanic

tympanoplasty

1.67, 2.54, 0.69,

(0.21)

Perichondrium

25 51 11

Acellular Cartilage

dermis

(0.002)

cholesteatoma pearl

(12) or middle

ear

cholesteatoma

membrane

2

(0.64)

Fifty-six

children

underwent

revision

surgery

for

tympanic children

(5).

Size > 50% < 50%

perforation

(42)

or

cholesteatoma

(14).

Five

membrane undergoing

(64.0) (74.0)

18 56

(36.0) (26.0)

1.60,

(0.16)

32

revision surgery

for a

tympanic membrane perforation

159

to chronic otorrhea.

underwent a concomitant mastoidectomy due

Location Anterior Posterior

(0.39)

revision

tympanoplasty

for

tympanic membrane

perforation

First was

86 52 30

(71.7) (70.3) (85.7)

34 22

(28.3) (29.7) (14.3)

1.0

successful

in

20/37

(54.1%)

children,

unsuccessful

in

14/37

1.07, 0.42,

(0.84) (0.10)

children

and was

unknown

in

3/37

(8.1%)

children.

(37.8%)

5

Central

results

are

shown

in in

Tables

4

and

5 .

All

age

groups

Hearing

significant

improvement

their

hearing

thresholds

post-

had

( p = 0.35), otorrhea

number

of

previous

tympanostomy

tubes

( p = 0.82), previous ( p = 0.77).

tympanoplasty different between and

the

hearing

thresholds were

not

significantly

in

the

6

months

prior

to

surgery

( p = 0.27),

the

three initial

age

groups. Children with

an

ongoing hearing

( p = 0.68)

or

previous

myringoplasty

after

the

tympanoplasty

had

poorer

adenoidectomy

perforation outcomes

children

were

more

likely

to

have

a

contralateral

than children with a successful tympanoplasty and had a

Pre-school perforation

( p = 0.02).

SRT

of

21.0 dB

( p = 0.25)

and

a post-operative ABG

post-operative

was

a

total

of

69

children

with

craniofacial

disorders

13.5 dB Logistic

( p = 0.02). regression

There

of

36

children

with

cleft

palate,

24

children

with

Down

analysis

revealed

that

covariates modifying

including syndrome

and

9

children with

other

craniofacial

disorders

such

a

association

between

perforation

post-tympanoplasty

and

the age

The

anatomical

success

rate

in

children

with

group

were

surgeon, etiology

surgical

approach

(transcanal

vs

craniosynostosis.

disorders was

between

70.8%

and

88.9%

and was

not

and

of

perforation.

Results may

be

found

craniofacial statistically

postauricular)

different

between

the

different

subtypes

of

craniofa-

Table

6 . Multivariate

analysis

revealed

that

after

adjusting

for

in

disorders

or

compared

to

children without

any

craniofacial

there

is

a significant difference between

the perfora-

cial

confounders

children with

craniofacial

abnormalities

did

not

rate

post-tympanoplasty

in

preschool

children

(age

2–4)

disorder. While

tion

a

decreased

anatomical

success

rate,

they were

significantly

( p = 0.04)

and

children

age

5–7

years

old

( p = 0.03)

compared

to

have

121