Pediatric Cartilage Graft Tympanoplasty: A Review of Factors Affecting Success

Introduction: Factors affecting pediatric tympanoplasty success remain controversial, especially age and graft material. We sought to evaluate success using cartilage grafts in pediatric tympanoplasty and provide evidence that age does not affect outcomes with proper patient selection.

Methods: We performed a retrospective chart review of patients 18 years and younger who underwent transcanal cartilage graft tympanoplasty between 2014 and 2022 by a single surgeon at our institution. Prognostic factors of age, previous adenoidectomy, perforation location and size, and revision status were identified. Patients were grouped by ages in years of 4-7 (27), 8-10 (22), and 11-18 (21). Perforation size was dichotomized to small ( < 50%) or large (50%+), defined as marginal or not and either anterior, inferior, or posterior. Preoperative and postoperative average air-bone-gap (ABG) was calculated using 500, 1000, 2000, and 3000 Hz. Outcomes were residual perforation, audiologic outcome, and need for revision tympanoplasty.

Results: In total, 66 patients were included. The average preoperative ABG was 21.32 dB and improved to 8.34 dB postoperatively (P < 0.001). Of the prognostic factors of age, previous adenoidectomy, perforation and size, and revision status, the only difference in distribution among groups was number of revision tympanoplasties performed in the older group (P = 0.001). Otherwise, factors were even amongst the groups. When evaluating outcomes, marginal perforation was associated with remnant perforation (P = 0.046) and audiologic failure (P = 0.003). Revision was associated with remnant perforation (P = 0.012) and need for revision tympanoplasty (P = 0.012). Age, perforation size and location, and previous adenoidectomy were not associated with negative outcomes.

Conclusions: This study supports pediatric cartilage graft tympanoplasty for successful structural and audiologic outcomes. It suggests younger age does not decrease success of tympanoplasty with proper patient selection. Instead, we found marginal perforation and revision tympanoplasty were the only factors that negatively impacted outcomes.