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

BMC Pediatrics

Research Article

Esmeralda Reyes-García¹  Nuria Esperanza Boronat-Echeverría¹  Yolanda Sevilla-Delgado¹  Héctor Aguirre-Mariscal¹  Juan Manuel Mejía-Aranguré² 

[1] 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, 06720, México City, Mexico;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, 06720, México City, Mexico;

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

DOI  :  10.1186/1471-2431-12-67

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

来源: Springer

【 摘 要 】

BackgroundTympanoplasty 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.MethodsSetting. 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.ResultsThe 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.ConclusionsThis 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】

Unknown   
© Boronat-Echeverría et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.