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
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