Introduction:

In children with tympanic membrane perforation, tympanoplasty aims to reconstruct the tympanic membrane to allow swimming and to create a well aerated, healthy, and hearing middle ear. Numerous surgical techniques have been developed and various graft materials used for the closure of tympanic membrane perforations, mainly fascia, fat, cartilage and perichondrium. The increased frequency of upper respiratory tract infections, otitis media, and eustachian tube dysfunction makes children at higher risk of surgical failure after tympanoplasty compared to adults (1).
Cartilage has become the preferential material for tympanic perforation closure in the child, due to its resistance in unfavourable local conditions, such as chronic infection or middle ear depression, which are frequent in the child. These may immediately impede healing or occur after closure and alter long-term results (2–5).
The importance of different factors and especially age at surgery remains debated in the literature (6–12). Also, the tympanic closure rate at 12 months follow-up or less does not seem sufficient to assess the success of the procedure in paediatric patients, due to frequent otitis media with effusion (OME) or post-operative retraction pockets or cholesteatoma in children (7,9,11,13). Long-term success rate should include tympanic closure without OME or post-operative complication and audiological results (13,14).
The aim of the study was to determine the factors that could influence the audiometric and functional results of cartilage tympanoplasty in children with tympanic membrane perforation, in a large cohort of children operated on with the same surgical procedure by paediatric otologists. The secondary objective was to determine the long-term three-year prognosis.