Cartilage shield tympanoplasty in children: review of 268 consecutive cases.
OBJECTIVE
To assess the efficacy of partial ossicular chain reconstruction using autologous cartilage.


METHODS
Prospective study (April 1, 1997, through January 1, 2008).


METHODS
Tertiary academic children's hospital.


METHODS
Two hundred forty-eight children (268 ears) underwent partial ossicular chain reconstruction using a shaped block of tragal cartilage interposed between the head of the stapes and an underlay tympanic membrane reconstruction along with tragal cartilage and its perichondrium.


METHODS
Anatomical and audiologic results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines. χ² Tests and multivariate analysis were used for statistical evaluation.


RESULTS
Mean age at surgery was 10.9 years. Single-stage surgery was performed in 124 ears (46.3%) (62.9% for cholesteatomas and 32.3% for retraction pockets). Second-look patients (53.7%) included 93.8% of staged surgery. Audiometric results were available for 222 ears at 1 year and for 78 ears at 5 years. Closure of the average air-bone gap (ABG) to within 20 dB was achieved in 62.2% of ears at 1 year. The mean (SD) preoperative and 1-year postoperative ABGs were 25 (11.8) dB and 18.9 (10.3) dB, respectively. Anatomical results were satisfactory in 87.3%. No cases of extrusion, resorption, or displacement of the cartilage were encountered. No statistically significant difference was found between audiometric results at 1 and 5 years. Multivariate analysis showed a significant negative correlation between preoperative and postoperative ABGs and between postoperative otitis media with effusion and postoperative ABG (P < .05).


CONCLUSIONS
Cartilage ossiculoplasty is a reliable technique for partial ossicular replacement. Long-term hearing outcomes remain stable and satisfactory. Preoperative ABG and postoperative otitis media are the predictive factors of the hearing outcome.
UMPC, Univ Paris, France. jerome.nevoux@trs.aphp.fr
Jérôme
J
Nevoux
Gilles
G
Roger
Pierre
P
Chauvin
Françoise
F
Denoyelle
Erea Noel
EN
Garabédian
D000293:Adolescent; D001301:Audiometry, Pure-Tone; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000601:surgery; D002908:Chronic Disease; D015331:Cohort Studies; D004425:Ear Cartilage / Q000637:transplantation*; D004429:Ear Ossicles / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006084:Graft Rejection; D006085:Graft Survival; D006776:Hospitals, Pediatric; D006801:Humans; D016015:Logistic Models; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000175:diagnosis / Q000601:surgery; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods*