Air space reduction tympanomastoidectomy repairs difficult perforations more reliably than tympanoplasty

[Obliteration of the middle ear cavity in children: the current state of the problem and our first experience]

Chronic otitis media is one of the most common ear pathologies among children. This article provides a short overview of publications on surgical techniques. Currently, the most effective treatment is the surgical sanitation of the middle ear cavities. There are two fundamentally different approaches of operations in relation to the posterior wall of the external auditory canal - «open» and «closed» types. Both methods have their advantages and disadvantages, which are especially noticeable in pediatric revision otosurgery. Surgical obliteration of the sanitized middle ear cavities is an effective compromise option. However, the techniques of bone obliteration, which are actively applied among adults, are difficult if we discuss children ear. A way out of this situation may be the use of modern osteoplastic materials for filling large trepanation cavities. The article describes in detail the technique of revision sanitizing surgery on the middle ear using osteoplastic granules. Purpose of the study. The analysis of the first results of separate obliteration of paratympanic cavities in children using osteoplastic materials.

MATERIAL AND METHODS

In the period from May 2018 to November 2020, on the basis of the Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health of Russia, 28 children aged from 6 to 17-year-old with chronic otitis media and cholesteatoma were operated using osteoplastic obliteration, who had previously sanitizing operation on the middle ear. All children on admission to the hospital and 6-12 months after the operation underwent a complex examination. The condition of each patient was assessed using the OMO-22 quality of life questionnaire, to which the parents answered the questions twice - before and 1 year after surgery.

RESULTS

During the postoperative period none of the patients had clinical signs of recurrence of cholesteatoma, which was confirmed by CT scan. When assessing the quality of life of children using a questionnaire, the average score before the operation was 130.2±27.7, after the operation - 61.5±21.1. The indicator of the bone-air interval before surgery in patients averaged 29.8±9.7 dB, 1 year after surgery - 13.0±10.9 dB (p>0.05).

FINDINGS

The first experience of using osteoplastic materials for obliterating the paratympanic spaces in children has shown high efficiency, ease of use and safety.

[Prospects of endoscopic otosurgery in children]

Active progress in otosurgery opens up new opportunities for minimally invasive surgeries and significantly improves the results of treatment, but a number of problems remain unsolved, including in children. Despite the general positive trend of using the endoscope in otosurgery, in pediatric practice the data are insufficient and extremely contradictory. Literary sources show that, with certain advantages, the existing techniques of endoscopic tympanoplasty are far from perfect and inferior in effectiveness to classical microscopic techniques, which also necessitates further research in this field.

Results of pediatric endoscopic and endoscopically assisted tympanoplasty

Objectives

To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty.

Methods

Retrospective review of single surgeon experience.

Results

During a 3 year period, 30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts. There were 22 boys and 8 girls, ranging in age from 3.5 to 17 years (median 6 years). All tragal cartilage grafts (31/31; 100%) survived. Twenty-seven surgeries (27/31; 82%) resulted in an intact drum (17/31; 55%) or a microperforation (10/31; 32%). In four cases (4/31; 13%) significant perforations formed in previously unaffected portions of the drum.

Conclusion

Transcanal endoscopic cartilage inlay tympanoplasty offers a practical, minimally invasive approach to tympanoplasty for children of any age. It avoids postauricular or endaural incisions, tympanomeatal flap elevation, and canalplasty. Graft survival is uniform. Microperforation at the graft margins remained in 1/3 of children. Technical modifications may lead to higher rates of tympanic closure.