Pediatric Cartilage Graft Tympanoplasty: Factors Affecting Surgical Success

OBJECTIVES: To identify prognostic factors affecting the success of pediatric cartilage graft tympanoplasty, with a specific focus on the impact of patient age and perforation characteristics. METHODS: A retrospective cohort study was performed identifying pediatric patients who underwent cartilage graft tympanoplasty between 2014 and 2022 by a single surgeon at a tertiary academic center. Factors affecting outcomes including sex, age, previous adenoidectomy, perforation location and size, and revision status were identified. Tympanoplasty success as defined by complete graft take as well as hearing improvement with closure of air-bone gap to ≤20 dB was assessed using Poisson regression. RESULTS: Our 74 patient sample with a total n = 78 tympanoplasties were majority female (56.4%) with mean (SD) age of 9.3 (3.2) years and had mostly anterior (46.8%) or posterior (35.1%) small (62.8%) central non-marginal (69.8%) tympanic membrane perforations. There was a success rate of 66.6% based on complete graft take without residual perforation and closure of the average air bone gap (ABG) to 20 decibels (dB) or less. Marginal perforations were the only significant predictor of an unsuccessful tympanoplasty (IRR [95% CI]: 0.59 [0.38, 0.90]). No other factors reached statistical significance, though trends suggested possible associations with revision surgery (0.77 [0.52, 1.16]), prior adenoidectomy (1.27 [0.95, 1.69]), and posteriorly located perforations (1.35 [0.98, 1.87 vs anterior). CONCLUSION: Marginal perforations negatively impacted tympanoplasty outcomes, and previous adenoidectomy and posterior location might predict successful outcomes. Younger age does not independently decrease success rate of tympanoplasty with proper patient selection.