title: Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  To study the effectiveness of Type 1 tympanoplasty for chronic tympanic membrane perforations in the pediatric age group and to investigate factors influencing its success.
  
  
  METHODS
  Searches were conducted of the MEDLINE database and the Cochrane Database of Systematic Reviews using terms focused around tympanoplasty and children. Searches were performed on June 23, 2014 and limited to English language entries since January 1, 1997.
  
  
  METHODS
  Studies reporting tympanoplasty closure rates in children 18 years and younger, with a minimum follow-up of 6 months, were included. Studies focusing on more advanced forms of tympanoplasty and revision surgery were excluded.
  
  
  METHODS
  Five hundred sixty-four articles were screened identifying 2,609 cases from 45 eligible studies. Data were collected by consensus of the first two authors with the third author arbitrating disparities of opinion. Success was taken as the closure rate at 12 months where possible.
  
  
  RESULTS
  Forest plots with Mantel-Haenszel analyses were used to compare closure rates with respect to perforation size, adenoidectomy, status of contralateral ear, Eustachian tube function, active infection, and graft position. Linear regression and Fisher's exact were used to analyze closure rate with respect to age.
  
  
  CONCLUSIONS
  The mean weighted closure rate for pediatric tympanoplasty was 83.4%. Subgroup analysis found age not to be a significant factor affecting the closure rate. Tympanoplasties performed on larger perforations or in children with abnormal contralateral ear findings were more likely to fail. Surgery may be best delayed until contralateral otitis media with effusion has settled.
authors.affiliation: *Department of Otolaryngology Head and Neck Surgery, University Hospital Coventry and Warwickshire, Coventry; †Department of Otolaryngology Head and Neck Surgery, Birmingham City Hospital, Birmingham; and ‡Department of Otolaryngology Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, U.K.
authors.forename: John
authors.initials: J
authors.lastname: Hardman
authors.forename: Jameel
authors.initials: J
authors.lastname: Muzaffar
authors.forename: Paul
authors.initials: P
authors.lastname: Nankivell
authors.forename: Chris
authors.initials: C
authors.lastname: Coulson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009225:Myringoplasty / Q000379:methods*; D010033:Otitis Media / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000601:surgery*