Success Rate In Children Research Articles

Mohs micrographic surgery for cutaneous malignancies: A focus review of its indications in pediatric age groups.

Mohs micrographic surgery (MMS) is a highly specialized technique that has been successful in the treatment of a variety of skin tumors. The technique can be performed as an outpatient procedure and encompasses surgical excision and intraoperative assessment of tumor margins in one setting by the same physician. The process ensures precise margin control with maximal preservation of healthy tissues. Mohs micrographic surgery has been practiced worldwide, including in the United States, Europe (United Kingdom, Germany, Spain, Netherlands, Switzerland), and Australia. Although it is commonly performed in adults with greater success, it has been discussed less frequently in children. In this article, we describe several cutaneous tumors in children and the role of Mohs micrographic surgery in their management. A PubMed search was conducted to review the most common cutaneous tumors in children treated using Mohs micrographic surgery. In this review, we discuss indications for Mohs micrographic surgery and pertinent studies examining success rates in children. Mohs micrographic surgery has been used to treat several tumors in children and offers the advantage of high cure rates and tissue conservation. This report emphasizes the benefits of Mohs micrographic surgery in children and highlights several cutaneous tumors for which it has been used to treat successfully.

Does the Application of Heat Gel Pack After Eutectic Mixture of Local Anesthetic Cream Improve Venipuncture or Intravenous Cannulation Success Rate in Children? A Randomized Control Trial

Needle-related procedures are the most common sources of pain for children in the hospital setting. The most used topical anesthetic, eutectic mixture of local anesthetic (EMLA) cream, may cause transient vasoconstriction. It has been postulated that this vasoconstriction may decrease vein visualization. The application of heat gel pack after removal of EMLA cream in the site of venipuncture counteracts the vasoconstriction, improving vein visualization. We assessed using a prospective randomized controlled trial whether the application of heat gel pack increases the needle procedure success rate. The primary study outcome was procedural success rate at the first attempt. The study enrolled 400 children, 200 of whom applied heat gel pack after removing EMLA (treatment group) and 200 did not (control group). Procedural success rate at the first attempt, vein perception before procedure, procedural pain, and adverse events were recorded in both groups. Eighty-eight percent of the procedures were successful at the first attempt in the treatment group and 89% in the control group (P = 0.876). Vein perception was not significantly different in the 2 groups (P = 0.081). Pain score after the procedure was similar in the 2 groups. This study shows that the application of heat gel pack after removal of EMLA cream does not improve venipuncture or intravenous cannulation success rate.

The Efficacy of Near-Infrared Devices in Facilitating Peripheral Intravenous Access in Children: A Systematic Review and Subgroup Meta-Analysis

Peripheral intravenous access is a common and invasive procedure that is performed in pediatric clinical settings. Children often have difficult intravenous-access problems that may not only increase staff stress but also affect the timeliness of immediate treatments. To determine the efficacy of near-infrared devices in facilitating peripheral intravenous access in children, using a systematic review and meta-analysis. Six databases, namely the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest were searched for related articles that were published between the earliest year available and February 2017. The search was limited to studies on populations of children that used either a randomized controlled trial or controlled clinical trial approach and used the key words "near-infrared devices" AND "peripheral intravenous access." The 12 articles that met these criteria were included in the analysis. The Cochrane Collaboration bias assessment tool was used to assess the methodological quality. In addition, RevMan 5.3.5 software was used to conduct the meta-analysis. The near-infrared devices did not significantly improve the first-attempt success rate, number of attempts, or the procedural time of peripheral intravenous access in children. However, the subgroup analysis of difficult intravenous-access factors revealed a significant improvement in the first-attempt success rate of children with difficult intravenous access scores (OR = 1.83, p = .03). Near-infrared devices may improve the first-attempt success rate in children with difficult intravenous access by allowing healthcare professionals to visualize the peripheral veins. Therefore, we suggest that the difficult intravenous-access score be used as a screening tool to suggest when to apply near-infrared devices to children with difficult peripheral intravenous access in order to maximize efficacy of treatment.

Two-year results of microcatheter-assisted trabeculotomy in paediatric glaucoma: a randomized controlled study.

To compare the outcomes of microcatheter-assisted circumferential trabeculotomy to standard rigid probe trabeculotomy in childhood glaucomas. Eyes of children requiring trabeculotomy for primary congenital or secondary paediatric glaucoma were randomized to undergo either trabeculotomy using the Glaucolight illuminated microcatheter, or a rigid probe trabeculotomy. Complete success was defined as an intraocular pressure (IOP) of <18mmHg without medications. A total of 62 eyes of 62 patients were included. Of these 30 eyes of 30 patients aged 5.6±4.8months underwent microcatheter-assisted trabeculotomy, with 15 eyes (50%) having a complete 360° cut, while 15 eyes (50%) had an incomplete cut ranging from 250 to 350 degrees. The rigid probe trabeculotomy group included 32 eyes of 32 patients aged 4.4±3.8months. At the end of the 2-year follow-up period, the complete success and the failure rates were 67% and 15%, respectively, in the microcatheter-assisted group versus 47% and 50% in the rigid probe trabeculotomy group (p=0.006). There was a tendency towards lower IOP in the microcatheter group at 1, 3, 6, 12 and 24months postoperatively, with the difference in IOP reaching statistical significance at 6months (p=0.004). The mean survival time was significantly longer for the microcatheter group (p=0.01). At 2years postoperatively, microcatheter-assisted trabeculotomy still yielded superior results in terms of IOP control and success rates in children with primary congenital glaucoma. The need for reoperation for glaucoma was significantly lower in the microcatheter group.

THE UTILITY OF FINGERPRINT-BASED PARTICIPANT IDENTIFICATION AND CONSENTING IN CLINICAL TRIALS IN DEVELOPING COUNTRY SETTINGS

BackgroundInvolvement in clinical research requires evidence of informed participant consent, and in many low-income countries with high illiteracy rates, this is done by a fingerprint impression on paper. Due to...

Efficacy of using Zaontz urethral stent in hypospadias repair by the Face, Legs, Activity, Cry, Consolability (FLACC) scale: A prospective study.

The developments in hypospadias surgical techniques and materials are intended to improve surgery outcomes and patient comfort. The aim of this study is to determine the effect of the Zaontz urethral stent (ZUS) (Cook Medical) on patient comfort and surgical success rates in children undergoing hypospadias surgery. A feeding tube was used to repair 46 cases of primary distal hypospadias, and ZUS (6F, 8F, and 10F in diameter) was used to repair to 31 cases of primary distal hypospadias between December 2009 and June 2011 in our clinic. ZUS was compared with the feeding tube in terms of surgical success rates and patient comfort in assessments made during postoperative periods. The patients with ZUS were followed with a stent for seven days postoperatively, as were the patients with the feeding tube. There was no statistical difference between the two groups in terms of fistula formation (p>0.05). Patient comfort was evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) scale on the first and third postoperative days, and a statistically significant difference was observed in favour of ZUS on the third postoperative day (p<0.05). Compared with a feeding tube in hypospadias repair, ZUS does not make any contribution to the urinary fistula rates. However, ZUS may have an advantage in terms of patient comfort in the postoperative followup. On the other hand, the small number of patients and the high price of the ZUS were the most important limitations. Prospective, randomized trials are needed to assess efficacy and cost.

I-gel versus Air-Q for airway maintenance during general anaesthesia with controlled ventilation in paediatrics

Background In the last few years, a number of supraglottic airway devices have been introduced in the clinical practice of airway management, trying to offer a simple and effective alternative to the endotracheal intubation. These devices are designed to overcome the disadvantages of endotracheal intubation such as soft tissue injury and exaggerated haemodynamic response. Purpose The aim of the present study was to compare between the I-gel and the Air-Q intubating laryngeal airway as alternative supraglottic airway devices during general anaesthesia with controlled ventilation in paediatrics. Patients and methods Sixty ASA grade I and II children, aged 3–6 years, and scheduled to undergo elective surgery under general anaesthesia with controlled ventilation in supine position were randomly categorized into two equal groups (30 patients each): group I, in which the I-gel was used to maintain a patent airway during anaesthesia; and group II, in which Air-Q intubating laryngeal airway was used to maintain a patent airway during anaesthesia. After induction of anaesthesia and muscle relaxation, we measured ease of insertion, time and number of trials to successful insertion, airway sealing pressure, fibrescopic view of the glottis, maintenance success, haemodynamic responses, airway interventional requirements and any other complications. Conclusion This study showed that both supraglottic airway devices are suitable for positive pressure ventilation with high success rates in children undergoing elective surgeries. It was found that the I-gel has a shorter time of insertion and a higher airway sealing pressure, whereas Air-Q has a better fibrescopic view of the glottis.

Intranasal dexmedetomidine for sedation in children undergoing transthoracic echocardiography study--a prospective observational study.

Intranasal dexmedetomidine has been used for sedation in children undergoing nonpainful procedures. The aim of this study was to determine the success rate of intranasal dexmedetomidine sedation for children undergoing transthoracic echocardiography examination. This was a prospective observational study of 115 children under the age of 3 years undergoing echocardiography examination under sedation with intranasal dexmedetomidine at 3 mcg·kg(-1). Of the 115 children, 100 (87%) had satisfactory sedation with intranasal dexmedetomidine. The mean onset time was 16.7 ± 7 min (range 5-50 min). The mean wake up time was 44.3 ± 15.1 min (range 12-123 min). The wake up time was significantly correlated with duration of procedure with R = 0.540 (P < 0.001). Aside from one patient who required oxygen supplementation, all children in this investigation had an acceptable heart rate and blood pressure and required no medical intervention. Sedation by intranasal dexmedetomidine at 3 mcg·kg(-1) is associated with acceptable success rate in children undergoing echocardiography with no adverse events in this cohort.

Spinal anaesthesia for orthopaedic surgery in children with cerebral palsy: analysis of 36 patients

Background and Objective: Cerebral palsy is one of the most common childhood neuromuscular diseases in the world. Spinal anaesthesia in children is an evolving technique with many advantages in perioperative management. The aim of this retrospective study was to provide first-hand reports of children with cerebral palsy who underwent orthopaedic surgery under spinal anaesthesia.Methods:Records of the children with cerebral palsy who underwent orthopaedic surgery under spinal anaesthesia between May 2012 and June 2013 at Selcuk University Hospital were investigated. In all patients, lumbar puncture was performed in lateral decubitus position with mask sevoflurane-nitrous oxide anaesthesia. In patients who were calm prior the spinal block, inhalation anaesthesia was terminated. In patients who were restless before the spinal block, anaesthesia was combined with light sevoflurane anaesthesia and a laryngeal mask. From anaesthesia records, the number of attempts required to complete the lumbar puncture, and the success rates of spinal anaesthesia and perioperative complications were noted. Data were expressed as numbers and percentages.Results:The study included 36 patients (20 girls and 16 boys). The mean age was 71 months. The rate of reaching subarachnoid space on first attempt was 86%. In all patients, spinal anaesthesia was considered successful. In 26 patients, laryngeal mask and light sevoflurane anaesthesia were required to maintain ideal surgical conditions. No major perioperative complications were observed.Conclusion:Spinal anaesthesia alone or combined with light sevoflurane anaesthesia is a reliable technique with high success rates in children with cerebral palsy undergoing orthopaedic surgery.

Dental pulp therapy for primary teeth in children undergoing cancer therapy

Childhood cancer treatment negatively affects the immune system, increasing the risk for bacteremia and septicemia. As the oral cavity is a major entry portal for pathogens into the bloodstream dental care in such children tends to be radical, favouring tooth extraction over less drastic treatments such as pulpotomy, the amputation of infected dental pulp. The present study aimed to compare pulpotomy treatment success rate in children with cancer receiving immunosuppressive therapy with that of healthy children, and investigate if unsuccessful pulpotomy treatment in oncologic patients may lead to systemic complications. Twenty-six medical records of children from a paediatric oncology referral centre who had dental pulpotomy treatment (in 41 teeth) while receiving active cancer care during the years 2006-2012 were compared with records of 41 randomly selected healthy children who had undergone pulpotomy treatment (41 teeth) in the same institute during these years. Clinical and radiographic data were collected during treatments and at the end of the follow-up period (six months post dental treatment). No statisticaly significant difference was found between pulpotomy success rate amongst the two groups. Treatments success rates in the study and control groups were 82.9% (± 5.9) and 90.2% (± 4.7), respectively. No patient in the study group suffered from sepsis from a dental origin during follow-up period. Pulpotomy in paediatric cancer patients did not increase the risk for bacteremia or systemic complications from oral origin. We therefore recommend the re-evaluation of the current protocol for treating paediatric oncology patients.

Younger is harder: Pre-hospital IV access success rates in children

Younger is harder: Pre-hospital IV access success rates in children

Evaluation of management of postpneumonic empyema thoracis in children

Background Empyema is a well-known sequelae of pneumonia, which is increasingly being reported in children despite strict management. The appropriate management remains controversial. The aim of this study was to evaluate different management options of postpneumonic empyema in children. Materials and methods A total of 330 patients were reviewed between 2002 and 2012; their ages ranged from 1.25 to 15 years, with a median age of 4.3 years. The various management procedures included thoracentesis (n= 11), chest tube drainage (n= 229), chest tube drainage with intrapleural fibrinolytic therapy (n =117), video-assisted thoracoscopic surgery (VATS) (n =35), and thoracotomy because of a trapped lung noted on admissions and failed procedures (n =94). Results Variable success rates were noted as follows: tube thoracotomy (48.24%), fibrinolytic treatment (68.37%), and VATS (85.71%). Postoperative complications (11.14%) included wound infection (n = 10), atelectasis (n= 18), delayed expansion (n= 7), and need for reoperation (n= 2). Four patients died (1.21%), two of them following thoracotomy, one patient after fibrinolysis, and one patient following VATS. Patients treated with thoracotomy recovered completely. Conclusion New therapeutic modalities had variable success rates in children with postpneumonic empyema. Thoracotomy is still needed as a last resort for cases unresponsive to chemical fibrinolysis and following failed thoracoscopy. Keywords : decortication, empyema, fibrinolysis, thoracotomy

Prehospital Peripheral Intravenous Vascular Access Success Rates in Children

Objective. Achieving successful peripheral intravenous (PIV) vascular access in children can be difficult. In the prehospital setting, opportunities are rare. Obtaining access becomes vital in emergent and life-threating conditions, such as seizures, hypoglycemia, and cardiac arrest. This study examines prehospital pediatric PIV attempts, success rates, and the impact of patient age. Methods. This was a retrospective chart review of patients aged 18 years or younger receiving prehospital PIV attempts from January 1, 2003, through May 31, 2011. Included cases were identified by querying electronic patient care reports for PIV attempts within the specified age range. The documentation of PIV attempts and successes was reported by emergency medical service providers. This study was approved by an institutional review board. Results. Throughout the 101-month study period, there were 261,008 ambulance responses. PIV attempts were made in 4188 patients aged 18 years or younger. PIV placement was successful in 3699 patients (88.3%) and failed in 489 (11.7%). Age was significantly associated with success. Each 1-year increase in age was associated with an 11% increase in odds of PIV success (odds ratio, 1.11; 95% CI, 1.09–1.12; p < 0.001). Success was lowest in patients younger than 2 years old, with an overall success rate of 64.1% (141/220). Accounting for multiple attempts, success was achieved in 53.0% of attempts (141/266). Conclusions. Prehospital PIV attempts are uncommon (2% of emergent responses). Success rates are significantly associated with patient age in the pediatric population and lowest in those aged 2 years or less. Consideration of alternative forms of vascular access in this population may be beneficial. Key words: ambulance; emergency medical services; intraosseous; intravenous; pediatric

Surgical results after one-muscle recession for correction of horizontal sensory strabismus in children

To report the success rates in children after one-muscle recession for sensory strabismus. The medical records of consecutive patients ≤18 years of age who underwent primary unilateral horizontal surgery for sensory strabismus measuring ≤30(Δ) from 2004 to 2010 were retrospectively reviewed. Data collected included age at surgery, sex, length of follow-up, procedure performed, pre- and postoperative deviation, and treatment of associated vertical strabismus. Success was defined as a final deviation within 10(Δ) of orthotropia. A total of 33 patients (16 males) were included. Mean age at surgery was 5.2 years (range, 6 months to 17 years) and mean follow-up was 36 months (range, 6 months-7.4 years). Age at surgery (P = 0.37) and follow-up (P = 0.79) were comparable in patients with esotropia (n = 12) and exotropia (n = 21). Mean preoperative deviation was 23.7(Δ) in the esotropia group and 24(Δ) in the exotropia group (P = 0.875). Successful postoperative alignment was achieved in 76% of esotropic patients and 92% of exotropic patients (P = 0.379). Lateral rectus recessions resulted in a mean correction of 2.8(Δ)/mm of recession compared to 3.0(Δ)/mm for medial rectus recessions (P = 0.71). Advantages of one-muscle recession include a high success rate, few over-corrections, relatively short duration of surgery, and an intact muscle should reoperation be indicated.

Percutaneous central venous catheterization through the external jugular vein in children: is inserting the guide wire into the superior vena cava essential for successful catheterization?

Background/purposeThe external jugular vein (EJV) is an attractive alternative for percutaneous central venous catheterization (PCVC), with fewer complications. The inability to pass the guide wire into the superior vena cava (SVC) is, however, a major reason for the failure of this approach. The authors report a modification of the Seldinger technique to increase the effectiveness of this procedure in children. MethodsBetween May 2008 and June 2009, we performed 100 PCVCs consecutively in children using the Seldinger technique through the EJV (Step 1). In cases in which the guide wire could not be passed into the SVC, the guide wire was kept in the EJV; and only the catheter was introduced into the central venous position (Step 2). Differences between the standard and modified Seldinger techniques were analyzed. ResultsThe procedure with the standard Seldinger technique (Step 1) was successful in 13 (13%) out of 100 patients. In 84 (96.5%) of the 87 remaining patients, PCVC was achieved with the modified Seldinger technique, without the insertion of the guide wire until the SVC (Step 2). Altogether, 97 catheters (97%) were successfully inserted, with 85 (87.6%) correctly positioned in the SVC. In addition, there were 7 (7%) clinically irrelevant hematomas during catheterization. ConclusionsThe EJV is an excellent alternative anatomical location for the completion of PCVC in children. Placing the guide wire in a central position is not essential to the success rate of this approach. The proposed modified Seldinger technique allowed PCVC to be performed through the EJV safely and with a high success rate in children and adolescents.

Which factors predict unsuccessful outcome in a weight management intervention for obese children?

Many obese children attending weight management interventions experience positive changes; however, not all are successful and little is known about what factors influence treatment outcome. The present study aimed to assess which baseline characteristics may predict unsuccessful treatment outcome in a weight management intervention for obese children. WATCH IT is a community weight management intervention for obese children and their families. Data collected during the pilot phase were visited retrospectively and secondary analysis was performed on the dataset. Inclusion criterion prioritised independent variables for the statistical model aiming to detect those that were exerting a significant effect. Logistic regression was used to assess the ability of these independent variables to predict unsuccessful treatment outcome. Seventy-eight children (mean age 11.9 years) who attended the WATCH IT weight management intervention for at least 6 months were included in the analysis. Multivariable regression analysis showed that children from families where both parents reported having a weight problem were six times more likely to be unsuccessful compared to children from families where neither parent reported weight problems (odds ratio = 6.1; 95% confidence interval = 1.2-32.0; P = 0.032). Age, gender, severity of obesity and duration of previous weight management attempts were not predictive of treatment outcome. To increase the overall success rate of children's weight management interventions such as WATCH IT, current approaches to behaviour change may need to be adapted or tailored for those families who are less likely to be successful. Supporting overweight parents to make their own successful lifestyle changes may be one way of improving the child's likelihood of weight management success.

Pain treatment after craniotomy

Pain following craniotomy has been demonstrated to be frequent and moderate-to-severe in nature. In recent years, the focus on the challenges in treatment of postoperative pain following craniotomy has increased. Fear of using opioids because of their wide array of side-effects has led to the search for alternative analgesic options. The objective of this systematic review was to evaluate current evidence about analgesic therapy following craniotomy. PubMed database, Embase, Cochrane library, Google scholar and the Cumulative Index to Nursing and Allied Health Literature. Randomised double-blinded placebo-controlled trials (RCTs) with pain or supplemental postoperative analgesic consumption as an endpoint were included in the analysis. A total of 34 RCTs were identified, and nine RCTs were included in the final analysis, with a total of 519 patients (251 control vs. 268 active treatment). Four treatment modalities - scalp infiltration (five RCTs), nerve scalp block (two RCTs), parecoxib (one RCT) and patient-controlled analgesia with morphine (one RCT) - were evaluated. Scalp infiltration with local anaesthetic may provide adequate analgesia in the first few postoperative hours, and nerve scalp block may provide longer lasting analgesia for about 6 h. Morphine was found to reduce total analgesic rescue doses with no significant effect on nausea and no other side-effects. No significant evidence was found to support the use of parecoxib in the treatment of postcraniotomy pain. No firm recommendations on analgesic therapy following craniotomy can be given because the number of well performed RCTs is limited and the study populations are very small. However, evidence on scalp infiltration suggests an analgesic effect in the first few postoperative hours. There is an urgent need for well performed RCTs on pain therapy following craniotomy.

Transvesicoscopic cross-trigonal ureteroneocystostomy in children: A single-center experience

PurposeTo evaluate the safety and efficacy of transvesicoscopic ureteric reimplantation in children. Patients and methodsSeventeen ureteric units in 11 patients underwent a transvesicoscopic ‘Cohen’ ureteroneocystostomy in 2003–2007 and the results were retrospectively analyzed. There were four boys and seven girls. All patients had vesicoureteric reflux (VUR), except for one with paraostial diverticula. Six patients underwent bilateral and five unilateral transvesicoscopic reimplantation (a total of 17 units). ResultsThe procedure was successfully completed in all patients. Mean operation time was 217min in unilateral cases and 306min in bilateral cases without perioperative complications, except for pneumoperitoneum development in two cases. In the early postoperative period, two patients developed macroscopic hematuria. Mean hospital stay was 3.8 days (3–5 days), except for one patient who suffered from urinary tract infection and needed longer hospitalization. Mean follow-up period was 4.5 years (3–7 years). One patient with bilateral VUR had passive unilateral grade I VUR on postoperative cystogram, giving a success rate of 91% (94% of ureters). This patient was followed conservatively. One patient had recurrent urinary tract infections without reflux. ConclusionTransvesicoscopic cross-trigonal ureteroneocystostomy can be safely performed with a high success rate in children.

The efficacy of safety barriers for children: absolute efficacy, time to cross and action modes in children between 19 and 75 months

We examined the efficacy of safety barriers by testing their capabilities to prevent or delay crossing. Children between 19 and 75 months tried to climb different barriers selected for their age group, which represented the most common types of panel and horizontal bars barriers available on the market. Success or failure in crossing, time to cross and crossing techniques were analysed. Barrier characteristics' influenced its restraining efficacy. Children's success rate varied between 10% and 95.3%. None of the barriers assured a considerable protective delay. Three major action modes were identified: head over waist (HOW), head and waist (HAW) and head under waist (HUW). Generally, children adopted the safer action mode, HOW, to cross most barriers. Younger children often adopted unstable action mode in barriers with crossable gaps. Although some standards might need to be re-evaluated, there are no childproof barriers. Barriers are time-delaying devices that cannot substitute supervision and education.

Tympanoplasty in children

Closure of uncomplicated tympanic membrane perforation (tympanoplasty) is usually a straightforward procedure with a good success rate. Many studies report a success rate from 60 to 99% in adults, whereas a 35-94% success rate in children. The definition of successful tympanoplasty varies from one author to other. Some authors report that an intact tympanic membrane considered a successful surgical result, whereas the other authors may also consider the postoperative hearing, as well as middle ear aeration, as a part of good outcome. This review is an insight into the recent and as well as the past literature on prognostic factors in pediatric tympanoplasty. This article reports an overview of the commonly reported factors which are thought to affect the tympanoplasty in children. Age is considered as one of the most important factor determining the successful outcome of tympanoplasty. Most of the studies did not reveal any significant difference in result between pediatric tympanoplasty from those of adult ones. Interestingly, in one study; it was found that patients younger than 16 years had decreased graft uptake compared with adults. However, in this same study; it was found that the younger patients had better postoperative hearing with better postoperative AB gap closure. The other factors which seem to influence the success rate of tympanoplasty are the size of perforation, technique used, presence or absence of otorrhoea, eustachian tube function and status of the contralateral ear. A study has revealed that posterior perforation had poorer results but it may be a distorted finding as the surgical method was not controlled. Regarding the size of perforation and its influence on the success rate of tympanoplasty, there is again difference of opinion. In one study, it was found that perforations greater than 50% had poorer results, but other studies contradict this statement stating that the success of tympanoplasty has no bearing with the size of perforation. Poor eustachian tube function has been offered as an explanation by some authors as younger age may be correlated with lower tympanoplasty success rates, but some authors refute this by stating that poor eustachian tube function not necessarily an indicator of poor surgical outcome. In conclusion, the success of tympanoplasty in children, with little doubt, depends on a number of factors. The past and recent literature has not produced a consensus of convincing evidence supporting any one parameter.