Prognostic factors of successful tympanoplasty in pediatric patients: a cohort study

BMC Pediatrics

Juan Manuel Mejía-Aranguré¹  Héctor Aguirre-Mariscal²  Yolanda Sevilla-Delgado²  Esmeralda Reyes-García²  Nuria Esperanza Boronat-Echeverría² 

[1] Unit of Research in Clinical Epidemiology, High Specialty Medical Care Unit of the Pediatric Hospital of the Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, México City, 06720, Mexico;Department of Pediatric Otorhinolaryngology, High Specialty Medical Care Unit of the Pediatric Hospital of the Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, México City, 06720, Mexico

关键词: Epidemiologic methods;    Otorhinolaryngologic surgical procedures;    Otologic surgical procedures;    Myringoplasty;    Tympanoplasty;   

Others  :  1170778
DOI  :  10.1186/1471-2431-12-67

 received in 2012-03-08, accepted in 2012-06-12,  发布年份 2012

【 摘 要 】

Background

Tympanoplasty in children is a current and controversial theme. The success of tympanoplasty traditionally has been measured only by the post-operative integrity of the graft. Yet, there are other variables that may be used to determine success. The objectives of the present work were to analyze which factors are predictive of successful tympanoplasty in pediatric patients and to construct and validate a prognostic index that could be used as a tool to predict the success of tympanoplasty in children.

Methods

Setting. Department of Pediatric Otorhinolaryngology, tertiary-care hospital, Mexico City. Patients. Forty-eight patients, who were older that five years of age, had persistent perforation of the tympanic membrane, and had undergone tympanoplasty (January 2005–June 2008), were followed for a year. Main Outcome Measures. The factors tested for their value as predictors were the following: age at time of surgery, state of contralateral ear, previous adenoidectomy, cause of perforation, size of perforation, infection at the time of surgery, state of mucosa, age at first occurrence of perforation, presence of craniofacial dysmorphia, and surgical technique. These factors were compared with the criterion, success, which was defined as attaining three positive outcomes: 1) integrity of the implant or membrane; 2) minimum of 10-dB gain in the auditory threshold or, in the case of normal hearing, conservation of same; and 3) air-filled space in the middle ear. The best model was obtained through logistic regression analysis; the model was validated.

Results

The most balanced prediction model was that in which the three success criteria were included, with age, surgical technique, and infection at surgery being excluded as variables. The additional 12 pediatric cases used in the validation had a probability of success >0.425 (best cut-off level); two patients (17%) had poor evolution.

Conclusions

This is the first study that validated a predictive index of the result of tympanoplasty in children. This index predicted 81% of the successful outcomes.

【 授权许可】

   
2012 Boronat-Echeverría et al.; licensee BioMed Central Ltd.

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