title: Myringoplasty in children.
abstract: BACKGROUND
  Tympanic membrane perforation (TMP) may be caused by acute and chronic otitis media, trauma and iatrogenic reasons. The goal of myringoplasty is to achieve a dry, self-cleansing ear with intact TM while preserving hearing. Literature review of myringoplasty outcome demonstrates results with different success rates and affecting factors.
  
  
  OBJECTIVE
  The aim of this study was to evaluate TMP closure (TMPC) rate and hearing improvement and to assess the effect of clinical and surgical parameters on residual and recurrent perforation.
  
  
  METHODS
  Retrospective chart analysis of pediatric patients who underwent myringoplasty between the years 2000-2015. Closure success rate and hearing improvement were evaluated. The influence of age and clinical and surgical variables over TMPC rate and recurrent perforation were examined.
  
  
  RESULTS
  Our study cohort consisted of 165 myringoplasties in 151 children, with a mean age of 11.7 years (R = 4.8-17.9, Me = 12.0). At one month follow-up (FU) TMPC rate was 88% (145/165). Among patients with successful TMPC a mean improvement of air bone gap (ABG) and speech reception threshold (SRT) were 9.9 dB, p < 0.001 and 9.4 dB, p < 0.001, respectively. 58/145 (40%) patients with initial closure had a minimum FU of 6 months (Me = 12.0), during which time 8/58(13.8%) had a recurrent perforation. Surgery before 9 years of age was the only factor correlated with failed initial closure (p = 0.03) and recurrent perforation (p = 0.02).
  
  
  CONCLUSIONS
  Pediatric myringoplasty is associated with high TMPC rate. Hearing improvement is to be expected in most hearing impaired patients. Age under 9 years is associated with significantly higher rates of persistent and recurrent perforation.
authors.affiliation: Sackler School of Medicine, Tel-Aviv University, Israel. Electronic address: noa.rzn@gmail.com.
authors.forename: Noa
authors.initials: N
authors.lastname: Rozendorn
authors.affiliation: Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel. Electronic address: Michael.Wolf@sheba.health.gov.il.
authors.forename: Michael
authors.initials: M
authors.lastname: Wolf
authors.affiliation: Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel. Electronic address: Arkadi.Yakirevich@sheba.health.gov.il.
authors.forename: Arkadi
authors.initials: A
authors.lastname: Yakirevich
authors.affiliation: Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel. Electronic address: Yisgav.Shapira@sheba.health.gov.il.
authors.forename: Yisgav
authors.initials: Y
authors.lastname: Shapira
authors.affiliation: Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel. Electronic address: Eldar.carmel@sheba.health.gov.il.
authors.forename: Eldar
authors.initials: E
authors.lastname: Carmel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006309:Hearing; D006320:Hearing Tests; D006801:Humans; D008297:Male; D009225:Myringoplasty; D010033:Otitis Media / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000209:etiology / Q000601:surgery*
keywords: Hearing; Myringoplasty; Pediatric; Success; Tympanic membrane perforation; Type I tympanoplasty