title: The effect of age on pediatric tympanoplasty outcomes: a comparison of preschool and older children.
abstract: OBJECTIVE
  Determine whether the outcome of tympanoplasty in preschool children is different from that of older children.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Retrospective review of children having undergone a primary tympanoplasty by 4 surgeons for a tympanic membrane perforation between 2002 and 2013.
  
  
  RESULTS
  Data from 50 children age 2-4, 130 children age 5-7 and 105 children age 8-13 years old were reviewed. Median follow-up was 7.5 months. On crude analysis, the incidence of anatomical success was not significantly different between the different age groups (p=0.38), the success rate was respectively 69.4%, 68.5% and 79.1% with an overall rate of 72.5%. 5.9% of all children required later insertion of tympanostomy tubes, 10.2% in preschool children. The post-operative audiology results were similar for all groups with a mean improvement of 9dB in the air-bone gap. When limiting the analysis to the 155 children having at least 6 months of follow-up, the rate of success was respectively 50.0%, 60.8% and 74.0% (p=0.10). After multivariate analysis controlling for the effect of surgeon, approach and etiology, the odds ratio of perforation was respectively 5.48, 2.27 and 1.00 for the different age groups.
  
  
  CONCLUSIONS
  Children younger than 4 years of age have the worst outcome after tympanoplasty. It remains uncertain whether the benefits of hearing improvement and quality of life may outweigh that of a high rate of a residual, usually smaller, perforation. Prospective studies are needed to confirm these results and delineate the patient characteristics and technique most likely to lead to successful results.
authors.affiliation: Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA. Electronic address: melanie.duval@muhc.mcgill.ca.
authors.forename: Melanie
authors.initials: M
authors.lastname: Duval
authors.affiliation: Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA.
authors.forename: J Fredrik
authors.initials: JF
authors.lastname: Grimmer
authors.affiliation: Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Meier
authors.affiliation: Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA.
authors.forename: Harlan R
authors.initials: HR
authors.lastname: Muntz
authors.affiliation: Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA.
authors.forename: Albert H
authors.initials: AH
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D018058:Tympanic Membrane Perforation / Q000601:surgery; D014433:Tympanoplasty
keywords: Age; Children; Myringoplasty; Tympanic membrane perforation; Tympanoplasty