Timing of tympanoplasty in children with chronic otitis media with effusion.
OBJECTIVE
Children with chronic otitis media with effusion resulting in repeat ventilation tube placement are at increased risk for perforation, an atelectatic ear, cholesteatoma, and hearing loss. The timing of intervention is controversial, and management strategies are variable. This update reviews the recent literature with a focus on groups at greater risk for requiring tympanoplasty, such as patients with craniofacial abnormalities including cleft palate and Down syndrome.


RESULTS
Patient age continues to show a debatable relationship to tympanoplasty success. The use of cartilage grafts shows equivalent results compared with traditional techniques. Cartilage provides a more robust scaffold, which can improve outcomes in difficult ears. Patients with cleft palate or Down syndrome have a significantly increased risk of Eustachian tube dysfunction and commonly require tympanoplasty, which necessitates careful consideration of timing and technique.


CONCLUSIONS
The timing of tympanoplasty is still under debate, with little concrete evidence to indicate absolute guidelines. Attention to patient age, craniofacial abnormalities, and graft choice will help to improve surgical success.
Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Larry D
LD
Hartzell
John L
JL
Dornhoffer
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*