Introduction

The performance of pediatric tympanoplasty is a matter of controversy in the literature, varying from 35 to 94%. Several authors argue that the performance of tympanoplasty should be delayed until 6–8 years old or even after 10 years old.

Objectives

To analyze the results of type I tympanoplasty in pediatric age and to identify possible prognostic factors.

Material and methods

Retrospective study of children undergoing type I tympanoplasty (Portmann's classification) between January 2012 and December 2018 in our hospital. The following variables were analyzed: age, gender, etiology, size and location of the perforation, operated ear, season of the surgery, experience of the surgeon, condition of the contralateral ear, previous otologic surgery, previous adenoidectomy, presence of tympanosclerosis, surgical approach, type of graft, tympanoplasty technique, pre and postoperative audiometric results and follow-up time. The integrity of tympanic membrane (TM) was defined as anatomical success at 6 months postoperatively and as functional success we defined a pure tone average < 20 dB (mean of 0.5–4 KHz) in postoperative tonal audiometry, performed between 3 and 6 months after surgery.

Results

A total of 48 ears operated on 38 patients, aged between 8 and 17 years. Anatomical and functional success rates of 81.3% and 87.5%, respectively, were obtained. The only statistically significant poor prognostic factor was the presence of tympanosclerosis plaques in the middle ear, negatively affecting anatomical success (p = 0.007) and functional success (p = 0.008). There was an anatomical failure rate of 25% in the anterior and lower TM perforations, 14.3% in central and 7.7% in posterior perforations (p = 0.603). Perforations >50% of the TM surface showed a functional failure rate of 25% vs. 10% in perforations <50% of the TM (p = 0.242) and anatomical failure rates of 12.5% vs. 20%, respectively (p = 0.620). Regarding age, the group <12 years had an anatomical success rate of 85.7%, while the group ≥12 years had a rate of 79.4% (p = 0.611). As for the functional success rates, this was 92.9% and 85.3%, respectively (p = 0.471). Apart from the presence of tympanosclerosis, no other variable was statistically significantly associated with surgical success.

Conclusions

Our study shows that type I tympanoplasty in pediatric age is a procedure with a high rate of anatomical and functional success. The presence of tympanosclerosis plaques in the middle ear was the only factor associated with poor anatomical and functional prognosis. Contrary to what has been described in some articles in the literature, in this study, the functional and anatomical success rates did not vary according to the age group.

中文翻译：

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儿科I型鼓室成形术——三级医院的结果

介绍

儿科鼓室成形术的性能在文献中存在争议，从 35% 到 94% 不等。几位作者认为鼓室成形术的表现应该推迟到 6-8 岁甚至 10 岁之后。

目标

分析儿科 I 型鼓室成形术的结果并确定可能的预后因素。

材料与方法

2012年1月至2018年12月我院接受I型鼓室成形术（Portmann分型）患儿的回顾性研究。分析了以下变量：年龄、性别、病因、穿孔的大小和位置、手术耳朵、手术季节、外科医生的经验、对侧耳朵的状况、以前的耳科手术、以前的腺样体切除术、鼓室硬化的存在、手术方法、移植物类型、鼓室成形技术、术前和术后测听结果和随访时间。鼓膜 (TM) 的完整性被定义为术后 6 个月的解剖成功，而作为功能成功，我们定义了术后 3 至 6 个月进行的术后音调测听中纯音平均值 < 20 dB（平均 0.5-4 KHz）外科手术。

结果

共有 48 只耳朵对 38 名年龄在 8 至 17 岁之间的患者进行了手术。获得的解剖和功能成功率分别为 81.3% 和 87.5%。唯一具有统计学意义的不良预后因素是中耳中鼓室硬化斑块的存在，对解剖成功 (p = 0.007) 和功能成功 (p = 0.008) 产生负面影响。前部和下部 TM 穿孔的解剖失败率为 25%，中央穿孔为 14.3%，后穿孔为 7.7%（p = 0.603）。穿孔 > 50% 的 TM 表面显示功能故障率为 25% 与 10% 穿孔 < TM 的 50% (p = 0.242) 和解剖故障率分别为 12.5% 和 20% (p = 0.620 ）。关于年龄，<12岁组解剖成功率为85.7%，而≥12岁组为79%。4% (p = 0.611)。至于功能成功率，分别为 92.9% 和 85.3% (p = 0.471)。除了存在鼓室硬化外，没有其他变量与手术成功有统计学显着相关性。

结论

我们的研究表明，儿科年龄的 I 型鼓室成形术是一种解剖和功能成功率很高的手术。中耳鼓室硬化斑块的存在是与解剖和功能预后不良相关的唯一因素。与文献中的一些文章所描述的相反，在本研究中，功能和解剖成功率并没有因年龄组而异。