title: A comparison of two myringoplasty techniques in Nepalese children: a prospective randomized trial.
abstract: BACKGROUND
  In children, the success of myringoplastywith temporalis fascia is lower compared to adults and cartilage as an alternative graft material has shown higher success rate.
  
  
  OBJECTIVE
  To compare results of myringoplasty using tragal cartilage palisades with the use of temporalis fascia in children with large tympanic membrane perforations.
  
  
  METHODS
  This is a prospective and randomized study conducted in children of age 6-14 years with large tympanic membrane perforation of more than two quadrants. Status of graft at or around 6 weeks after surgery was used as morphological outcome measure. Pre- and postoperative audiograms were compared to evaluate audiological outcome in two groups.
  
  
  RESULTS
  Forty seven out of 55 patients completed follow-up. The graft uptake rate in the cartilage palisades and temporalis fascia myringoplasty group was 91.3% (21/23) and 83.33% (20/24), respectively; the difference was not statistically significant (P=0.666). The mean preoperative air-bone gaps (ABG) in cartilage palisades and temporalis fascia group were 36.2±8.9dB and 33.8±7.5dB, the difference was not statistically significant (P=0.412). Similarly, the postoperative ABG in cartilage palisades and temporalis fascia group were 25.1±12.2dB and 17.2±9.2dB, respectively, the difference was statistically significant (P=0.040). The gap closure was 11.0dB in palisades group and 16.8dB in fascia group, but it was not significant (P=0.133).
  
  
  CONCLUSIONS
  In our study of pediatric myringoplasty, the morphological and functional outcomes in both cartilage palisades and temporalis fascia groups were comparable.
authors.affiliation: Children's Hospital for Eye, ENT and Rehabilitation Services (CHEERS), BP Eye Foundation, Manohara, Bhaktapur, Nepal. Electronic address: prashantiom@gmail.com.
authors.forename: Prashant
authors.initials: P
authors.lastname: Tripathi
authors.affiliation: Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal.
authors.forename: Rajendra Prasad
authors.initials: RP
authors.lastname: Guragain
authors.affiliation: Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal.
authors.forename: Chop Lal
authors.initials: CL
authors.lastname: Bhusal
authors.affiliation: Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal.
authors.forename: Sureshwar Lal
authors.initials: SL
authors.lastname: Karna
authors.affiliation: Department of Otolaryngology, Tergooi Hospital, Rijksstraatweg 1, 1261AN, Blaricum, Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Borgstein
mesh_terms: D000293:Adolescent; D001299:Audiometry; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006309:Hearing / Q000502:physiology*; D006320:Hearing Tests; D006801:Humans; D008297:Male; D009225:Myringoplasty / Q000379:methods*; D009390:Nepal; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000503:physiopathology / Q000601:surgery*
keywords: Cartilage palisades; Children; Chronic otitis media; Large perforation; Myringoplasty; Temporalis fascia