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Mallouk S, Khadi EB, Bijou W, Oukessou Y, Sami R, Redallah LA, Mohammed M. Specific aspects of tympanoplasty in children: A retrospective cohort study of 95 cases. Ann Med Surg (Lond) 2021; 65:102297. [PMID: 33981425 PMCID: PMC8082206 DOI: 10.1016/j.amsu.2021.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Paediatric tympanoplasty is now a common surgical procedure. The age from which it could be proposed varies regarding children specificities such as Eustachian tube dysfunction, the high incidence of upper airway infections and the immaturity of the immune system. The aim of this study is to describe the specific constitutional, epidemiological and operative aspects as well as the anatomical and functional results of tympanoplasty in children. METHODS From 2014 to 2018, a cohort of 95 patients with ages between 6 and 16 years, operated for a type I tympanoplasty, was reviewed by analysing the medical history, the epidemiological and clinical parameters, in addition to the operative features and the functional results. RESULTS The mean age at surgery was 11,7 years. The main risk factors of tympanic perforation were recurrent otitis (78,9%), auricular trauma (16,8%) and tonsillar and adenoid hypertrophy (7,4%). Good anatomical postoperative results with a closed and reinforced neo-tympanic membrane were seen in 90 (94,7%) cases, while a significant improvement of the hearing loss was observed in 87 (91.6%) patients, with a mean value of 34,23 dB HL before and 21,9 dB HL after surgery (p < 0,0001). CONCLUSIONS The indications of type I tympanoplasty in the paediatric population remain a subject of debate, but still offer good anatomical and functional results as long as it is adapted to each particular case.
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Affiliation(s)
- Sanaa Mallouk
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - El Bouhmadi Khadi
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Walid Bijou
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Youssef Oukessou
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Rouadi Sami
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Larbi Abada Redallah
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Mahtar Mohammed
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
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Khanal P, Guragain RP, Bhusal CL. Comparison of postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty: A randomized controlled trial. Int J Pediatr Otorhinolaryngol 2020; 131:109893. [PMID: 31981921 DOI: 10.1016/j.ijporl.2020.109893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty. METHODS This is a prospective, randomized controlled study conducted in children of age 6-15 years with chronic otitis media (COM) mucosal, inactive type undergoing myringoplasty. Postoperative infection over a period of 4 weeks and status of graft at or around 3 months after surgery was studied as outcome measure. RESULTS Fifty five out of sixty children completed follow-up. The overall postoperative infection rate was 5.4%. Postoperative infection rate was 3.5% in children receiving prophylactic antibiotic and 7.4% in children receiving no antibiotic. There was no statistically significant difference in postoperative infection between two groups (P > 0.05). The overall graft uptake rate was 87.27%. It was 85.7% in antibiotic used group and 88.8% in non-antibiotic group with no statistically significant difference (P > 0.05). CONCLUSIONS Postoperative infection following myringoplasty in children is uncommon as it is a clean type of surgery. There was no statistically significant difference in postoperative infection and graft uptake rate by the use of prophylactic antibiotic in the intraoperative period. This study shows no benefit of a prophylactic antibiotic on postoperative infection or graft success in myringoplasty in children. TRIAL REGISTRATION NUMBER NCT03700814.
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Affiliation(s)
| | | | - Chop Lal Bhusal
- Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal
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Baklaci D, Guler I, Kuzucu I, Kum RO, Ozcan M. Type 1 tympanoplasty in pediatric patients: a review of 102 cases. BMC Pediatr 2018; 18:345. [PMID: 30400861 PMCID: PMC6220466 DOI: 10.1186/s12887-018-1326-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate the success of type 1 tympanoplasty in pediatric patients with chronic otitis media, and to evaluate the prognostic factors that may influence its success. Materials and methods Medical records of 102 children aged between 8 and 18 years (46 female, 56 male) who underwent type 1 tympanoplasty for chronic tympanic membrane perforation between January 2010 and July 2017 were reviewed. Age, gender, condition of contralateral ear (unilateral, bilateral), type (central, marginal) and location of perforation (anterior, posterior, inferior), graft material (fascia, cartilage), pre- and post-operative hearing levels, mean air-bone gap (ABG), surgical approach (postauricular, endaural) and length of follow up were recorded. Results Anatomical and functional success (ABG < 20 dBHL) rates were 86.3% (88 patients) and 74.5% (76 patients) after a mean follow-up of 32 ± 16.55 months, respectively. The mean hearing improvement was 10.77 ± 10.45 dBHL. The graft success rates were significantly higher in tragal cartilage group (95.1%) than in temporalis fascia group (80.3%) (p = 0.033). Graft success was negatively affected by contralateral perforation (p = 0.003). All patients with bilateral perforations and graft failure were in temporalis fascia group. Age, type and location of perforation and surgical approach did not influence graft success (p > 0.05). Conclusion Our results showed that type 1 tympanoplasty can be performed effectively in pediatric population regardless of age, location and type of perforation and surgical approach. Bilateral perforations are prone to reperforation, and should be treated with cartilage graft.
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Affiliation(s)
- Deniz Baklaci
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey.
| | - Ismail Guler
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
| | - Ihsan Kuzucu
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
| | - Rauf Oguzhan Kum
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
| | - Muge Ozcan
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
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Farinetti A, Farah C, Triglia JM. Myringoplasty in Children for Tympanic Membrane Perforation: Indications, Techniques, Results, Pre- and Post-Operative Care, and Prognostic Factors. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rozendorn N, Wolf M, Yakirevich A, Shapira Y, Carmel E. Myringoplasty in children. Int J Pediatr Otorhinolaryngol 2016; 90:245-250. [PMID: 27729143 DOI: 10.1016/j.ijporl.2016.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tympanic membrane perforation (TMP) may be caused by acute and chronic otitis media, trauma and iatrogenic reasons. The goal of myringoplasty is to achieve a dry, self-cleansing ear with intact TM while preserving hearing. Literature review of myringoplasty outcome demonstrates results with different success rates and affecting factors. OBJECTIVES The aim of this study was to evaluate TMP closure (TMPC) rate and hearing improvement and to assess the effect of clinical and surgical parameters on residual and recurrent perforation. MATERIALS AND METHODS Retrospective chart analysis of pediatric patients who underwent myringoplasty between the years 2000-2015. Closure success rate and hearing improvement were evaluated. The influence of age and clinical and surgical variables over TMPC rate and recurrent perforation were examined. RESULTS Our study cohort consisted of 165 myringoplasties in 151 children, with a mean age of 11.7 years (R = 4.8-17.9, Me = 12.0). At one month follow-up (FU) TMPC rate was 88% (145/165). Among patients with successful TMPC a mean improvement of air bone gap (ABG) and speech reception threshold (SRT) were 9.9 dB, p < 0.001 and 9.4 dB, p < 0.001, respectively. 58/145 (40%) patients with initial closure had a minimum FU of 6 months (Me = 12.0), during which time 8/58(13.8%) had a recurrent perforation. Surgery before 9 years of age was the only factor correlated with failed initial closure (p = 0.03) and recurrent perforation (p = 0.02). CONCLUSIONS Pediatric myringoplasty is associated with high TMPC rate. Hearing improvement is to be expected in most hearing impaired patients. Age under 9 years is associated with significantly higher rates of persistent and recurrent perforation.
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Affiliation(s)
- Noa Rozendorn
- Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Michael Wolf
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Arkadi Yakirevich
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Yisgav Shapira
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Eldar Carmel
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
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Migirov L, Wolf M. Transcanal microscope-assisted endoscopic myringoplasty in children. BMC Pediatr 2015; 15:32. [PMID: 25884359 PMCID: PMC4387589 DOI: 10.1186/s12887-015-0351-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 03/19/2015] [Indexed: 11/24/2022] Open
Abstract
Background Myringoplasty can be technically difficult in the pediatric patients due to the narrowness of the external auditory canal and the generally small size of the ear. Moreover, temporalis fascia grafts and myringoplasties for anterior perforations are more likely to fail in children. Surgical management of anterior perforations requires total exposure of the anterior angle however a microscope may fail to provide a view of the anterior edge in most of perforations. Recently, different endoscopes are used in the performance of ear surgery in general and myringoplasty in particular. Current study aimed to investigate the outcome of transcanal microscope-assisted endoscopic myringoplasty in homogenous group of children. Methods The medical records of 22 children were retrospectively reviewed for age, perforation size and location, surgical and audiological findings, and outcome. All myringoplasties were performed by first author with a chondro-perichondrial graft that has been harvested from the tragus and placed medial to the tympanic membrane remnants, utilizing the underlay technique and 14-mm length, 3-mm diameter, 0° and 30° endoscopes. A microscope was occasionally used for removal of the sclerotic plaques and releasing adhesions surrounding the ossicles when bimanual manipulations were needed. Surgical success was defined as a tympanic membrane with no perforation, retraction, or graft lateralization for at least 18 months following surgery. Results Thirteen large-, 8 medium- and 1 small-sized perforations (defined as 75, 50 or 25%, respectively, of the tympanic membrane area), of which 14 were anterior, 2 central and 6 posterior marginal, were repaired. The edges of the defect could not be visualized under a microscope due to bone overhanging or a curved or narrow EAC in 8 anterior perforations. Intact tympanic membranes and dry ears were achieved in all operated children. The audiometric air conduction level (average of 0.5-3 kHz) for the entire cohort ranged between 10–51.3 dB (mean 32.8) preoperatively and between 5–35 dB (mean 18.2) postoperatively. Conclusion The transcanal microscope-assisted endoscopic myringoplasty had a 100% rate of surgical success in children. This technique can be especially appropriate for patients with narrow external canals, anterior defects and bone overhang making the perforation margins barely visible under a microscope.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 5262l, Israel.
| | - Michael Wolf
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ben Gamra O, Nacef I, Abid W, Hariga I, Mbarek C. Myringoplasty in children: Our results. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ejenta.2014.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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