Cartilage graft in pediatric endoscopic tympanoplasty shows good results

Children 10 years old and younger do just as well as older children with endoscopic type 1 tympanoplasty for repairing perforated ear drums, a new 80-patient study shows.

The findings confirm that it is not necessary to wait until a child reaches puberty to repair the ear drum, Dr. Osama G. Abdel-Naby Awad, of Minia University Hospital in Minia, Egypt, told Reuters Health by email. Also, Dr. Awad added, while these operations are typically performed with microscopes, the findings show that endoscopes can be used with good results.

Dr. Awad and Dr. Khalf Hamid, also of Minia, report on a series of 80 patients treated with endoscopic type 1 tympanoplasty, using split-thickness tragal cartilage for grafting, in an article online April 30 in JAMA Otolaryngology-Head & Neck Surgery. Forty patients were 10 and younger, and 40 were older than 10. All were treated with the endoscopic inlay approach using a 2.7 mm endoscope.

Thirty-four patients in the younger group (85%) had complete healing of their perforation, as did 36 (90%) children in the older group. Improvement in the air-bone gap (ABG) occurred in 75% of the younger group and 80% of the older group. Mean ABG was 8.0 dB in the younger group and 10.5 dB in the older group. The operations, all performed by Dr. Awad, lasted a median 55.03 minutes.

The surgery tended to be more successful in patients who had undergone adenotonsillectomy previously, but the difference was not statistically significant.

Dr. Awad said he and his colleagues are now investigating using the endoscopic approach to cleaning the middle ear in patients with chronic otitis media with cholesteatoma.

“Our new approach for tympanoplasty in children eliminates the need for the painful incisions to take the graft from behind the ear, which helps the children for better compliance throughout the follow-up period and improves these kids’ lifestyle,” he added.