Do mastoidectomy and type of graft affect tympanoplasty outcome in Egyptian children? A prospective randomized study

Abstract

BackgroundThe purpose of this study is to evaluate and compare surgical and hearing outcomes of tympanoplasty using temporalis fascia graft and tragal cartilage with or without mastoidectomy in children with tubotympanic chronic suppurative otitis media.Two hundred children with chronic suppurative otitis media of tubotympanic type with perforation were included in this prospective randomized study. They were divided randomly into four equal groups according to operation done. Group I underwent tympanoplasty using temporalis fascia graft with cortical mastoidectomy, while in the second group, tragal cartilage was used as a graft with mastoidectomy. Groups III and IV were done without mastoidectomy, with tragal cartilage for group III and temporalis fascia for group IV. One-year follow-up was done for all patients to evaluate graft success (means without perforation nor retraction). Audiological evaluation was done for all children preoperatively and 6 months postoperatively for patients with successful graft uptake.ResultThere were 170 patients (85%) with graft success postoperatively. Tympanoplasty using temporalis fascia graft showed highly statistically significant difference (P < 0.001) when compared to tragal cartilage as regards hearing improvement in patients with successful graft uptake, while there is no statistically significant difference as regards graft uptake (P = 0.039). Also, there is no statistically significant difference between different techniques with or without mastoidectomy (P = 0.165).ConclusionTympanoplasty using temporalis fascia without cortical mastoidectomy is the surgery of choice in children between 10 and 16 years old with tympanic membrane perforation as it showed highly statistically significant difference when compared to tragal cartilage graft as regards hearing improvement, with no statistically significant difference regarding successfully graft uptake.