Approach to Chronic Otitis Media in pediatric patients
Approach to Chronic Otitis Media in pediatric patients
Approach to Chronic Otitis Media in pediatric patients
Mahtab Rabbani Anari, M.D. Assistant Professor Department of
Otorhinolaryngology – Head & Neck Surgery, Amir Alam Hospital, Tehran
University of Medical Sciences ,Tehran , Iran
Tympanic membrane perforation is a common pediatric otolaryngology problem specially happens after ventilation tube extrusion, complicated otitis media, or trauma.
Some important complications and consequences of untreated perforations included conductive hearing loss, speech delays, chronic otorrhea, and the need for precautions during water sports, and cholesteatoma. Therefore surgery is mandatory in the absence of spontaneous healing. The methods of surgery, the graft material and the timing of treatment are the sources of challenge.
The reported success rate of repair varies according literature from %35 to %94, which is lower than in the adult population. In this brief presentation I review the current evidences to find the role of predictor factors such as Eustachian tube function, duration, size, and location of the perforation, status of the contralateral middle ear and adenoid hypertrophy in the result of pediatric tympanoplasty. Controversies exist in terms of the optimal age to repair tympanic membrane perforations. Based on a part of available data there should not be a minimum age cutoff for considering tympanic membrane repair. On the other hand some authors recommended a minimum age to consider tympanoplasty ranging from 6 to 8 years. Cartilage tympanoplasty and butterfly-cartilage technique have been popular in this practice. Nowadays, totally or assisted endoscopic ear surgery in pediatric tympanoplasty is recommended. I also try to address these issues in this lecture.
Bilateral same-day endoscopic transcanal cartilage tympanoplasty:
initial results.
Daneshi A, Jahandideh H, Daneshvar A, Safdarian M.
INTRODUCTION: Same-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications.
OBJECTIVE: To evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations.
METHODS: From February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5cm×1.5cm cartilage seemed to be enough for tympanoplasty in both sides.
RESULTS: Nine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was %94.44 (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88dB preoperatively to 9.16dB postoperatively (p<0.05).
CONCLUSION: Bilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications.