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



METHODS
Department of Pediatric Otorhinolaryngology, tertiary-care hospital, Mexico City.


METHODS
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.


METHODS
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.
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.
Nuria Esperanza
NE
Boronat-Echeverría
Esmeralda
E
Reyes-García
Yolanda
Y
Sevilla-Delgado
Héctor
H
Aguirre-Mariscal
Juan Manuel
JM
Mejía-Aranguré
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D009225:Myringoplasty; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000601:surgery*; D014433:Tympanoplasty