Endoscopic myringoplasty in pediatric patients: a comparison of cartilage graft push-through and underlay fascia graft techniques

Abstract

Background

Although myringoplasty is performed in pediatric patients, there is still no consensus on the graft material and surgerical procedure.

Objective

To compare the short-and long- term graft take rates of the cartilage push-through and fascia graft techniques employed during pediatric myringoplasty.

Materials and methods

93 pediatric patients with perforation who underwent myringoplasty were randomized into the cartilage push-through and underlay fascia graft group. The outcomes evaluated were hearing gains, and graft success rates at 12 and 24 months.

Results

The graft success rate was similar between two groups (95.7% vs 91.3%, p = .653) at postoperative 12th months, however, the graft success rate was significantly higher 91.5% for the cartilage graft group compared with 73.9% for the fascia group at postoperative 24th months. No significant between-group differences were observed pre- (p = .694) or post- (p = .812) operative ABG values or mean ABG gain (p = .745).The re-perforation rate in fascia group was significantly higher than that in push through group (19.05 vs. 4.44%). No middle ear cholesteatoma formation was found in either group.

Conclusion

Endoscopic cartilage push-through and underlay fascia graft myringoplasty afforded comparable hearing results in pediatric patients; however, the push-through technique without the elevation of a tympanomeatal flap exhibited better long-term graft success rate compared to underlay fascia graft.

Chinese abstract

背景：尽管对儿科患者进行鼓膜成形术, 但关于移植材料和外科手术程序仍未达成共识。

目的：比较儿科鼓膜成形术中使用的软骨穿通和筋膜移植技术的短期和长期移植接受率。

材料与方法：对93例小儿穿孔患者行鼓膜成形术。随机分为软骨穿通和底层筋膜移植组。评估的结果是在12个月和24个月时的听力改善及移植成功率。

结果：术后12个月, 两组的移植成功率相似（95.7％对 91.3％, p¼.653）, 但是, 术后24个月, 软骨移植成功率显著高于筋膜移植组, 分别为91.5％和73.9％。两组间的术前ABG值（p¼.694）或术后（p¼.812）或平均ABG增益（p¼.745）没有重大差异。筋膜组的再穿孔率明显高于穿通组（19.05％对4.44％）。两组均没发现中耳胆脂瘤形成。

结论：内窥镜软骨穿通法和底层筋膜鼓膜成形术对小儿患者可提供类似的听力结果；然而, 与底层筋膜移植相比, 不抬高鼓膜瓣的穿通技术表现出更好的长期移植成功率。

Keywords:

• Cartilage graft
• Children
• Endoscope
• Myringoplasty
• Push-through technique

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Science and Technology Agency of Yiwu city, China [Grants#2018-3-76].