Pediatric myringoplasty: Postaural versus transmeatal approach

Objectives: Where various surgical options exist for solving the same problem, and the results are similar, Occam's razor may be a suitable way of deciding which technique to use. The postaural [retroauricular] approach in myringoplasty is favoured generally, for its reported better overview of the middle ear. However, due to increasing interests in both patients' comfort and a more efficient use of operating time, transmeatal approach is a good alternative. The aim of this study is to investigate the difference in success rates between these two approaches and the factors that contribute to success. Methods: Retrospective case note study. Cases that achieve tympanic membrane (TM) closure, within 1-year post-operative are considered to be successful. Patients: A group of 218 ears in 180 patients (median age 10.0, range from 5 to 18 years) who had undergone either postaural or transmeatal myringoplasty with or without ossicular reconstruction. Age, gender, site and size of the perforation, underlying cause of the perforation and status of contralateral ear were recorded. The patients were followed at 6 days, 7 weeks and then every 6 months to determine the incidence of TM closure. Audiograms were taken preoperatively, at 7 weeks and between 7 and 15 months post-operative. Results: The overall success rate was 78.9%. The difference in the success rates of the two approaches, 79.8% of postaural myringoplasty against 78.4% of transmeatal myringoplasty, is not significant (p=0.81). Post-operative air bone gap (ABG) is significantly improved when compared to that of preoperative(p <= 0.01). Younger age (5-6 years old) is associated with a lower success rate. Though their hearing is significantly improved, the difference is clinically irrelevant. Conclusion: Postaural and transmeatal approaches in myringoplasty have comparable closure rate. Occam's razor would in this situation indicate the use of the simplest/fastest technique with the lowest morbidity; in this situation the transmeatal approach. Since younger age is associated with lower success rate, it is recommended to postpone surgery until the age of 7 is reached. (C) 2009 Elsevier Ireland Ltd. All rights reserved.