Paediatric Type I Cartilage Tympanoplasty with or without Concomitant Adeno-tonsillectomy – An Institutional Experience
Article Sidebar
Main Article Content
Abstract
Introduction
In the management of COM in paediatric age group, eradication of the septic foci in the tonsil and the adenoids while addressing the dysfunction of Eustachian tube play a key role This study aims to assess the success rate of type I tympanoplasty with cartilage graft in mucosal type of chronic otits media in paediatric age group and finally, whether concomitant adeno-tonsillectomy plays any role in outcome of surgery or curing the disease process.
Materials and Methods
A prospective clinical study was done over a period of one and half years amongst 59 patients, aged between 5 and 12 years, presenting with chronic otitis media with dry central perforation of ear-drum and pure conductive hearing loss. Patients were divided into two groups. Group 1 (n1= 22) underwent type I cartilage tympanoplasty with adenoidectomy/ tonsillectomy/ both in the same sitting and Group 2 (n2= 37) underwent type I cartilage tympanoplasty without any adeno-tonsillectomy.
Results Graft uptake was 86.4% in Group 1 at 6 months post-operative follow up while that in Group 2 was found to be 86.5%. The mean hearing gain in two groups were found to be 15.91±6.54 dB and 17.02±8.96 dB respectively. No significant difference was found between graft uptakes and hearing gains in two groups at the end of the study.
Conclusion
Type I cartilage shield tympanoplasty, may be considered as an effective management strategy of paediatric chronic otitis media, mucosal disease. Type I tympanoplasty with concomitant adeno-tosillectomy did not prove to be better than type I tympanoplasty alone in terms of anatomic closure of tympanic perforation and hearing gain.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Charles D. Bluestone; Epidemiology; Eustachian Tube: structure, function, role in otitis media. Vol 2, BC Decker 2005; 11-12
Hamilton J. Chronic otitis media in childhood; Scott Brown’s Otorhinolaryngology, Head and Neck Surgery, 7th ed, 2008; volume 1; Hodder Arnold; 933
Bluestone CD. Anatomy; Eustachian Tube: structure, function, role in otitis media; Vol 2, Hamilton BC Decker, 2005; 25-32
Bluestone CD. Physiology; Eustachian Tube: structure, function, role in otitis media; Vol.2, Hamilton BC Decker, 2005; 51-66
Bluestone CD, Eustachian Tube: Structure, Function, Role in Otitis Media; Vol. 2; Ch. 5, Ed. Bluestone MB; 2005, BC Decker 2005; 67-91
Darrow D H, Derkay CS. Otitis Media; Complications in Pediatric Otolaryngology; Ed. Josephson GD, Wohl DL. Broken Sound Parkway NW, Taylor & Francis 2005; 445
Bluestone CD. Eustachian tube function: physiology, pathophysiology and role of allergy in pathogenesis of otitis media. J Allergy Clin Immunol. 1983; 72(3): 242-51
Bluestone CD. Conquering Otitis Media, An illustrated guide to understanding, treating and preventing ear infections; Ed. Bluestone MB; Ch.5, BC Decker 1999; 16-24
Szalmás A, Papp Z, Csomor P, et al. Microbiological profile of adenoid hypertrophy correlates to clinical diagnosis in children. Biomed Res Int. 2013;2013:629607. doi:10.1155/2013/629607
Saafan ME, Ibrahim WS, Tomoum MO. Role of adenoid biofilm in chronic otitis media with effusion in children. Eur Arch Otorhinolaryngol. 2013 Sep; 270(9): 2417- 25
Dornhoffer JL. Cartilage tympanoplasty. Otolaryngol Clin N Am. 2006; 39: 1161-76
Buchwach KA, Birck HG. Serous otitis media and type 1 tympanoplasties in children. A retrospective study. Ann Otol Rhinol Laryngol Suppl. 1980; 89(3 Pt 2):324-5
Vrabec JT, Deskin RW, Grady JJ; Metaanalysis of Pediatric Tympanoplasty; Arch Otolaryngol Head Neck Surg.1999; 125(5):530-4
Boronat-Echeverría NE, Reyes-García E, Sevilla-Delgado Y et al. Prognostic factors of successful tympanoplasty in pediatric patients: a cohort study. BMC Pediatrics 2012, 12:67. https://doi.org/10.1186/1471-2431-12-67
MacDonald RR 3rd, Lusk RP, Muntz HR. Fasciaform myringoplasty in children. Arch Otolaryngol Head Neck Surg. 1994; 120(2):138-43. doi:10.1001/archotol.1994.01880260010003
Koch WM, Friedman EM, McGill TJ, Healy GB. Tympanoplasty in children. The Boston Children's Hospital experience. Arch Otolaryngol Head Neck Surg. 1990;116(1):35-40. doi:10.1001/archotol.1990.01870010039013
Shih L, de Tar T, Crabtree JA. Myringoplasty in children. Otolaryngol Head Neck Surg. 1991; 105: 74-7
Raine CH, Singh SD. Tympanoplasty in children: A review of 114 cases. J Laryngol Otol. 1983; 97(3):217-21
Knapik M, Saliba I. Pediatric Myringoplasty: a study of factors affecting outcome. Int J Pediatr Otorhinolaryngol. 2011; 75(6): 818-23
Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993; 103:1352-1356
Amedee RG, Mann WJ, Riechelmann H. Cartilage palisade tympanoplasty. Am J Otol. 1989; 10(6):447-50
Duckert LG, Muller J, Makielski KH, et al. Composite autograft “shield” reconstruction of remnant tympanic membranes. Am J Otol. 1995; 16(1):21-6
Ross MH, Romrell LJ. Connective tissue. In: Histology: a text and atlas, vol. 89, 2nd ed. Baltimore, Williams and Wilkins 1989.
Singh I. editor. Textbook of human histology. New Delhi Jaypee Brothers Medical Publishers 2004; 89-93
Zahnert T, Huttenbrink KB, Murbe D, Bornitz M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol. 2000; 21:322-8 26. Mürbe D, Zahnert T, Bornitz M, Hüttenbrink KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope 2002; 112(10):1769-76. doi:10.1097/00005537-200210000-00012
Gianoli GJ, Worley NK, Guarisco JL; Pediatric Tympanoplasty: the role of adenoidectomy; Otolaryngol Head neck Surg. 1995;113(4): 380-6
Charlett SD, Knight LC. Pediatric myringoplasty: does previous adenoidectomy improve the likelihood of perforation closure? Otol Neurotol. 2009; 30(7):939-42
Ophir D, Porat M, Marshak G. Myringoplasty in the pediatric population; Arch Otolaryngol Head Neck Surg. 1987; 113(12): 1288-90
Vartiainen E, Vartiainen J. Tympanoplasty in young patients: the role of adenoidectomy; Otolaryngol Head neck Surg. 1997; 117(6): 583-5
Wohl DL, Belenkay WM. Otologic Surgery; Complications in Pediatric Otolaryngology. Eds. Josephson GD, Wohl DL. Broken Sound Parkway NW, Taylor & Francis 2005; 480
El-Hennawi DM. Cartilage perichondrium composite graft (CPCG) in pediatric tympanoplasty. Int J Ped Otorhinolaryngol. 2001; 59(1):1-5
Couloigner V, Baculard F, El Bakkouri W, Viala P, et al. Inlay Butterfly Cartilage Tympanoplasty in Children. Pediatric Otology and Neurology 2005; 26(2):247-5
Gaslin M, O‘Reilly RC, Morlet T, McCormick M. Pediatric cartilage
interleave tympanoplasty. Otolaryngol Head Neck Surg. 2007; 137(2):284-8
Albirmawy OA. Comparison between cartilage-perichondrium composite “ring” graft and temporalis fascia in type one tympanoplasty in children. J Laryngol Otol. 2010; 124(9); 967-74
Nevoux J, Roger G, Chauvin P, Denoyelle F, Garabedian EN. Cartilage shield tympanoplasty in children: review of 268 consecutive cases; Arch Otolaryngol Head Neck Surg. 2011; 137 (1): 24-9
Friedman AB, Dornhoffer JL. Outcomes of cartilage tympanoplasty in pediatric patients. Otolaryngol Head Neck Surg. 2012; 147(2 suppl):102
Yilmaz MS, Guven M, Kayabasoglu G, Varli AF. Comparison of the anatomic and hearing outcomes of cartilage type 1 tympanoplasty in pediatric and adult patients. Eur Arch Otorhinolaryngol. 2015; 272(3):557-62. doi:10.1007/s00405-013-2869-2.