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Role of Mastoidectomy with Type 1 Tympanoplasty in Paediatric Patients with Poor Contralateral Ear Status

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Abstract

The aim of the study was to assess the role of mastoidectomy with type 1 tympanoplasty in the management of paediatric patients with poor contralateral ear status and to evaluate the prognostic factors that may influence the success outcome of type 1 tympanoplasty. A prospective study of 112 paediatric patients from 4 to 12 years of age. All patients in the study had bilateral ear perforations. They were randomly assigned to undergo either type 1 tympanoplasty (group 1, n = 56) or type 1 tympanoplasty with mastoidectomy (group 2, n = 56). The outcomes between the two groups were compared at 12 months postoperative period. The outcomes evaluated were: 1. anatomical condition of the tympanic membrane, 2. functional improvement in hearing (≥ 10 db), 3. air-filled middle ear space without atelectasis or otitis media with effusion, 4. overall outcome. The outcomes were also compared in both the surgical groups for patients who were ≤ 8 years (n = 51) and > 8 years (n = 61) of age. Prognostic factors for success outcome for type 1 tympanoplasty were evaluated. The prognostic factors considered were age at the time of surgery, age groups, duration of the disease prior to surgery, previous adenoidectomy, mechanism of perforation, location of perforation, size of the perforation, type of ear surgery performed (tympanoplasty with or without mastoidectomy). The success outcome in anatomical condition of the tympanic membrane was significantly higher in mastoidectomy group (p = 0.015) but was not significantly different in those ≤ 8 years and > 8 years (p = 0.112, p = 0.064 respectively).There was no difference in the functional improvement in hearing in both the surgical groups for all patients, ≤ 8 years and > 8 years (p = 0.188 p = 0.061, p = 0.865 respectively). Mastoidectomy group showed significantly higher success outcome for air-filled middle ear space without atelectasis or OME for all patients, ≤ 8 years and > 8 years (p < 0.001, p = 0.004, p = 0.041 respectively).Overall success was significantly higher in mastoidectomy group for all patients and ≤ 8 years (p = 0.040, p = 0.012 respectively),but not significantly different for > 8 years (p = 0.592).Out of the prognostic factors considered for success only the type of ear surgery performed showed as a better predictor for success (AUC = 0.606, p = 0.046). Cortical mastoidectomy done along with type 1 tympanoplasty in paediatric patients with poor contralateral ear showed statistically significant higher overall success outcome. Although mastoidectomy done with type 1 tympanoplasty showed better success outcome in patients above 8 years, it was not statistically significant. Except the type of ear surgery performed, none of the prognostic factors considered could influence the success outcome. Our study recommends mastoidectomy to be combined with type 1 tympanoplasty in paediatric patients aged ≤ 8 years with poor contralateral ear status to enhance the overall success outcome.

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Data Availability

Data collected and documented while individual patients included in the study were treated at military hospitals.

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Funding

This research did not receive any specific Grant from any funding agencies.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, 166 Military Hospital, Satwari Cantonment, Jammu, Jammu and Kashmir, 180003, India

    Mohan Raghav Guthikonda

  2. Department of Pathology, Gayatri Institute of Health Care and Medical Technology, GVP Medical College, Maridi Valley, Marikavalasa, Visakhapatnam, Andhra Pradesh, 530048, India

    Aswini Gude

  3. Department of Otorhinolaryngology-Head and Neck Surgery, INHS Asvini, Near RC Church, Colaba, Mumbai, Maharashtra, 400005, India

    Rahul Naga

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  1. Mohan Raghav Guthikonda
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  2. Aswini Gude
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  3. Rahul Naga
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Correspondence to Aswini Gude.

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The authors declare that they have no conflict of interest.

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All medical and surgical interventions performed in this study involving the human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all individual patients included in the study.

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Guthikonda, M.R., Gude, A. & Naga, R. Role of Mastoidectomy with Type 1 Tympanoplasty in Paediatric Patients with Poor Contralateral Ear Status. Indian J Otolaryngol Head Neck Surg 74 (Suppl 1), 631–638 (2022). https://doi.org/10.1007/s12070-021-02457-4

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  • DOI: https://doi.org/10.1007/s12070-021-02457-4

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