Post-operative results after tympanoplasty with cartilage palisades in underlay technique in children

Introduction Few studies report the recurrence rate of perforation or retraction after tympanoplasty in children. We report our experience with cartilage palisades in comparison with other grafts in children.

Methods A retrospective study among children (< 18 years of age) who received tympanoplasty between 2010 and 2020 was performed. The following techniques were evaluated: approximately 2 mm wide cartilage palisades (CP), temporal fascia (TF) and cartilage perichondrium island (CPI). The changes between pre- and post-operative conductive hearing loss (AC), Air-Bone Gap (ABG) and recurrence of perforation or retractions were compared.

Results 130 children (59 male; 71 female) were included with mean age 9.6 ± 3.8 years. 103 children had chronic otitis media, 19 cholesteatoma and 8 adhesive process. CP group included 50 children, TF 45 children and CPI 35 children. The reduction in mean ABG after surgery was the highest in the CP group (3.7 dB). The ABG increased by 1.4 dB in TF group and decreased minimally by 0.7 dB in CI group. The mean increase in AC was the highest in the CP group with a significant difference (8.9 dB; p<0,05). The CP group showed the lowest rate of recurrent perforation (16%), compared to TF (24.4%) and CPI (20%). The CP group also showed lowest rate of retraction (4%), compared to TF (6.6%) and CPI (5.7%). Children with cholesteatoma showed 10 times more odds of developing retraction of the tympanic membrane post-operatively (OR= 10.3, 95% CI: 1.1- 97.0, p =0.042).

Conclusion Air conduction hearing loss improved significantly when using cartilage palisades compared to temporal fascia and cartilage perichondrium island graft. Reconstruction with cartilage palisades resulted in lesser post-operative perforations and retractions in children.

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Artikel online veröffentlicht:
12. Mai 2023