The results of tympanoplastic surgery to repair a perforation of the tympanic membrane are less satisfactory in children than in adults. This paper reports the results of a prospective study of 45 children (51 ears) which was undertaken to determine which, if any, detectable and controllable pre or intraoperative parameters might predict the outcome of tympanoplasty surgery. A “successful” tympanoplasty was defined as that in which the initial graft took, in which the tympanic membrane remained intact, and which was not associated with high negative middle ear pressure, otitis media with effusion, or cholesteatoma during a follow-up period of one to two years. Assessment of hearing related to the tympanoplastic surgery was not included as an outcome measure. With this criteria, the overall success rate of tympanoplasty in children was 35%.
The success of tympanoplasty was not related to graft placement, although the laterally placed grafts had a higher take rate (67%) than grafts placed medially (49%). Preoperative measures, such as the assessment of Eustachian tube function using the modified inflation-deflation test and tympanometric evaluation of the contralateral ear, failed to predict the success of tympanoplasty. Tympanoplasty universally failed in the ears in which an acquired cholesteatoma was present. Children remain uncertain candidates for tympanoplasty surgery since, as a group, their Eustachian tube function is not as good as that of adults.