TYMPANOPLASTY FOR THE ANTERIOR SUPERIOR PERFORATION IN CHILDREN

Anterior-superior perforations of the tympanic membrane have proven mo re difficult to repair than other perforations, and many investigators have found such repairs to be problematic. We report a technique in w hich the tympanic membrane is released from the malleus, and the graft is placed medial to the remnant, lateral to the malleus, and medial t o the tympanomeatal flap. In a series of 42 cases the short-term surgi cal success rate (represented by an intact graft at 6 months) was 98%, with 95% of ears remaining free of reperforation to the end of follow -up. Postoperatively, 90% of children had an air-bone gap of 20 dB or less and 100% of children had an air-bone gap of 30 dB or less. Eighty -seven percent of subjects demonstrated a speech reception threshold ( SRT) of 20 dB or better, whereas 100% of subjects demonstrated an SRT of 30 dB or better. These results compare favorably with those reporte d at this institution for repair of perforations of any quadrant in ch ildren, and those of other investigators for anterior superior perfora tions in adults.