Myringoplasty in children: Predictive factors of outcome

Objectives: To assess the results of myringoplasty in children and to deter mine which factors independently influence the postoperative results. Study Design: Retrospective study of the anatomic and functional results of 231 consecutive myringoplasties performed in 188 children between 1988 and 1992 . Multivariate analysis of poor prognostic factors by cross-sectional compa rison I year after surgery. Methods: Myringoplasties were performed via an endaural approach with a fascia temporalis underlay graft. Results: In 216 of 231 ears (93.5%) the tympanic membrane was closed, A good anatomic outco me was considered to have been achieved in 188 ears (81.6%), although in 18 ears (7.8%) seromucous otitis media occurred, in 8 ears (3.5%) a progressi ve retraction pocket was encountered, and in 2 ears significant lateralizat ion was present. One hundred thirty-nine (67.5%) of the 206 ears tested in the postoperative period had a postoperative air-bone gap of 10 dB or less. On average, mean bone conduction remained unaltered. The age of the patien t and the size and the lo cation of the perforation did not affect the outc ome. Three prognostic factors for an abnormal postoperative tympanic membra ne were found, with 95% confidence intervals: inflammatory changes in the m iddle ear mucosa (P <.05), contralateral tympanic perforation (P <.05), and contralateral cholesteatoma (P <.01), Conclusions: Myringoplasty with unde rlay grafting of the fascia temporalis in children gives good anatomic and functional results. Inflammatory changes within the middle ear mucosa, cont ralateral tympanic perforation, and contralateral cholesteatoma independent ly influence the risk of an abnormal postoperative tympanic membrane. The p resence of one of these factors preoperatively should lead to the considera tion of alternative, more durable graft material, such as autologous cartil age.