Results:
In this study, 139 ears (127 patients) were included, 57 males and 70
females. Comorbidities were as follows: 16 patients (13%) had
craniofacial malformations (including ten with a velopalatal cleft), 25
patients were diagnosed with allergic rhinitis (20%).
Mean age at surgery was 9.6 years ± 2.6 (Figure 2 ).
Perforation was in the right ear in 74 cases (53% of ears) and in the
left ear in 65 cases (47%). No clinical symptom was present in 49 cases
(35%). Preoperative auditory evaluation is reported in
Table 1 . The size of the perforation was available for
109 ears (78%): pinpoint size one ear (1%), up to a quarter of the
eardrum’s surface in 34 ears (31%), up to half of the eardrum in 38
ears (35%) and more than half of the surface to total in 36 (33%).
Location of the perforation was available in 137 ears (99%): posterior
in 24 cases (18%), inferior in 28 cases (20%), anterior in 47 cases
(34%), subtotal or central in 36 cases (26%) and multiple in two
(2%).
All procedures were performed with an endaural approach and an underlay
tragal cartilage graft. Procedures were performed by a senior paediatric
otologist in 57 cases (47%) and by a junior otolaryngologist (10 years’
experience or less) in 65 cases (53%). There was a preoperative
external auditory canal stenosis in 17 cases (12%). During the
procedure, the atrial mucosa was inflammatory (abnormal mucosa or
otorrhoea) in 45 ears (33%) and glue in the middle ear was found in
nine ears (7%).
At one-year anatomical assessment follow-up, 129 (93%) tympanic
membranes were closed. Satisfactory anatomical result (closure without
OME, retraction, cholesteatoma or myringitis) was observed in 112 ears
(81%). The unsatisfactory results are detailed in Table
2 . Notably, two children had developed a severe retraction pocket with
cholesteatoma and nine an evolutive retraction pocket at one-year
follow-up. Of those patients, 3/11 had cleft palate, 2/11 had
contralateral tympanoplasty and mean age at surgery was 9.2 years.
Audiometry data one year after surgery were available for 127 ears
(91%) and reported in Table 1 . Audiometric results were
considered good (residual air conduction ≤ 20 dB) in 102 ears (80%). In
five ears (4%) the bone conduction threshold was increased by more than
10 dB. Both anatomical and audiometric success (satisfactory anatomical
and audiometric results) was obtained in 84 ears (66%).
The otoscopic data at three-years post-surgery were available for 66
ears (47% of 139 ears). Among the 52 ears which were satisfactory at
one year, six (12%) became unsatisfactory at three years (including one
reperforation, two OME and three cases of myringitis). Of the 14 ears
which were unsatisfactory at one-year follow-up, 10 became satisfactory
and four remained unsatisfactory (including one cholesteatoma, one
perforation with myringitis and two cases of myringitis). Overall, at
three years follow-up, the tympanic membrane was closed in 64/66 ears
(97%) and the result was satisfactory in 56/66 ears (85%). Myringitis
was the most frequent cause of poor result (six ears, 9%), detail in
Table 2 . The median air conduction threshold was 15dB
[12.5; 22.5] with 26/32 (81%) of ears considered as having a good
functional result (auditory data available for 32 ears, detail in
Table 1 ). Overall success at three years (both
satisfactory anatomical and audiometric results) was obtained in 24/32
ears (75%). Air conduction audiometry was significantly better at
one-year and three-years follow-up versus pre-operative values
(difference at 1 year -6dB [-10;0] p<0.001; difference at
3 years -2dB [-13;1] p = 0.034).
The univariate analysis of risk factors of non-satisfactory TM at
one-year follow-up identified only one significant risk factor. Patients
operated on under the age of eight years had 31% of non-satisfactory
results at one-year follow-up (versus 14% at the age of eight or over,
p=0.024). The other risk factors (size, anterior or subtotal
perforation, various associated pathologies, other age groups) were not
associated with higher risk of non-satisfactory TM (Table
3 ). When analysing tympanic perforation locations separately
(posterior, inferior/central, anterior, subtotal or multiple locations),
no statistical difference in outcome at one year was found (p = 0.20).