Experiencia en miringoplastía transcanal con pericondrio tragai inlay / Experience in transcanal myringoplasty with inlay tragal perichondrium

Introducción: La timpanoplastía está orientada a la reconstrucción anatomofuncional del oído medio que realizada en la membrana timpánica se denomina miringoplastía. Objetivo: Evaluar los resultados anatomofuncionales de la miringoplastía transcanal con pericondrio tragal inlay en pacientes intervenidos en el Servicio de Otorrinolaringología del Hospital San Camilo entre 2004 y 2009. Material y método: Estudio retrospectivo descriptivo de fichas de 56 pacientes entre 7 y 77 años. Universo: 60 oídos, muestra: 48 oídos con edad promedio de 34 años. Se evaluaron resultados anatómicos según sexo, edad, ubicación, causa de perforación y mejoría funcional objetivada por audiometría. Resultados: La integridad anatómica posquirúrgica es de 81,3% sin diferencias según género. Según edad existe diferencia significativa de 93,3% para el tramo 7-19 años respecto del total. Las perforaciones centrales tuvieron un éxito de 100%. La causa más frecuente de perforación fue por otitis media crónica simple (75%) con una integridad posquirúrgica del 80,5%. El 97,6% logró mejorar o mantener el nivel de audición, estableciéndose diferencialmente mejoría funcional en 52,4%, y una mantención en 45,2%. Conclusión: Los mejores resultados para esta técnica se obtienen en menores de 20 años con perforaciones centrales, siendo una técnica ideal que conserva la estructura de la membrana timpánica para futuras intervenciones.

Introduction: Tympanoplasty is orientated to the anatomofunctional reconstruction of the middle ear, which is named myringoplasty, when performed in the tympanic membrane. Aim: To evaluate the anatomofunctional results of transcanal myringoplasty with inlay tragal perichondrium in patients controlled in the Otorhinolaryngology Unit of San Camilo Hospital, between 2004 and 2009. Material and method: Retrospective descriptive study on files of 56 patients between 7 and 77 years of age. Universe: 60 ears, sample: 48 ears with average age 34 years. Anatomical results were evaluated according to sex, age, location, cause of perforation and functional improvement measured by audiometry. Results: The overall anatomical postsurgical integrity is 81,3 % without differences between sexes. According to age there is a significant difference for the section between 7-19 years of age respect of the total (93,3 %). Central perforations had a 100% success rate. The most frequent reason of perforation was simple chronic otitis media (75%) with a postsurgical integrity of 80,5 %. 97,6 % managed to improve or maintain hearing level, (52,4 % gained functional improvement, and 45,2 % maintained hearing level). Conclusion: Using this technique, best results are obtained in patients younger than 20 years of age, with central perforations. It is an ideal method that preserves the structure of the tympanic membrane for future interventions.

A long term view of myringoplasty in children.

Fifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiological outcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.