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Objectives: To determine the true success rate of pediatric myringoplasty., Materials and Methods: This retrospective study analyzed 67 pediatric myringoplasties performed at Hyogo College of Medicine between 2000 and 2009. We divided the pediatric population into a younger group (<10 yr old, n = 41) and an older group (≥10 yr old, n = 26). We also compared the pediatric group (n = 67) with a group of adult patients (n = 63) who underwent myringoplasty between 2008 and 2009., Results: In the pediatric group, graft success was achieved in 81% of the cases. The pathologic success rate, which was based on the presence of an intact membrane without adhesion, retraction, or effusion, was 73%. Furthermore, an intact membrane with successful hearing was achieved in 67% of the cases at 12-month follow-up. The graft success rate of the adult group was 90%, and there was no significant difference with the pediatric group. However, when success was defined as pathologic success or pathologic success with hearing improvement, there were significant differences in success rates between pediatric and adults groups (p < 0.05). The success rate of pathologic success with hearing improvement was significantly lower in children with abnormal contralateral ears or poor contralateral air cell development than in children with healthy contralateral ears (p < 0.01) or good contralateral air cell development (p < 0.05)., Conclusion: These findings suggest that the success of pediatric myringoplasty should be defined as an intact tympanic membrane without evidence of adhesions, retraction, or effusion, together with hearing improvement at the 12-month follow-up.

The objectives of the retrospective study, performed at a tertiary referral center, were to examine the prognostic factors predicting long-term outcomes of tympanoplasty for perforated chronic otitis media (COM) and to determine whether mastoidectomy can be avoided during tympanoplasty for perforated COM. Between 1987 and 2002, 213 patients with perforated COM underwent tympanoplasty by the same surgeon and were followed for more than 5 years. Postoperative hearing outcomes were considered successful, if the postoperative air-bone gap was within 20 dB. Closure of perforation by a single surgery was considered a successful graft. Long-term outcomes were analyzed using logistic regression analysis. Normal ossicular chain was the only factor that showed a significantly favorable relation to long-term hearing outcomes. There were no significant predictors of long-term successful graft outcomes. Mastoidectomy was not a significant factor predicting long-term outcomes. Our long-term outcomes showed that mastoidectomy can be an avoidable surgical procedure in tympanoplasty for perforated COM, even if the ear is infected.

Objective: To evaluate the results of bilateral same-day surgery for bilateral perforated chronic otitis media in comparison with our previous report., Study Design: Prospective study., Patients: Seventeen patients ranging in age from 5 to 70 years (mean, 52.5 yr), with bilateral perforated chronic otitis media., Methods: Two hundred cases of chronic otitis media were operated on at the Department of Otolaryngology, Hyogo College of Medicine from December 1998 to November 2002. Fifty-nine patients (29.5%) had bilateral disease and 17 patients (8.5%) underwent bilateral same-day surgery., Results: The postoperative air-bone gap was less than 10 dB on both sides in 5 of 17 (29%) and less than 20 dB in 15 of 17 (88%). The postoperative hearing level was less than 20 dB in both ears in 4 of 17 (24%), less than 30 dB in 7 of 17 (41%), and less than 40 dB in 10 of 17 (59%). The rate of closure of the ear drum was 20 of 22 (91%) in the simple underlay myringoplasty series and 9 of 12 (75%) in the conventional myringoplasty/tympanoplasty series. The rate of closure of the ear drum on both sides was successful in 4 of 5 (80%) that underwent simple underlay myringoplasty/simple underlay myringoplasty and 8 of 12 (67%) that underwent simple underlay myringoplasty/conventional myringoplasty/tympanoplasty, whereas that on at least one side was successful in 100%., Conclusion: Bilateral same-day surgery for bilateral perforated chronic otitis media is possible if operative indications are considered. Furthermore, it will help patients save time and money.

Objective: Very few reports are available in the literature to clarify the natural long course of hearing change in an individual patient with chronic otitis media (COM). We reviewed hearing change in patients suffering from perforated COM without an operation., Methods: Eighty-seven ears of 70 patients had COM with tympanic perforation and were observed without an operation. The mean follow-up period was 10.7 years (5-22 years) and the mean age at the first examination was 51.3 years. To minimize the effect of aging, 23 patients with normal ear drums on the other side were further analyzed., Results: All 87 ears tended to show deterioration of hearing gradually under long observation. In 23 patients, hearing deterioration was 0.13 dB/year in the control side and 0.61 dB/year in the COM side (P < 0.02). Although elevation of bone conduction hearing level tended to be larger at high frequencies than at low and middle frequencies, there was no significant difference between COM and normal ears., Conclusions: Air conduction hearing levels deteriorated with the passage of time and surgery is recommended at the early stage of COM to prevent progress of hearing loss.

Objective: Bilateral same day surgery has been performed rarely because of the risk of postoperative sensorineural hearing loss following conventional myringoplasty or tympanoplasty (CMT). Simple underlay myringoplasty (SUM) through the ear canal has been developed by Yuasa R, Saijo S, Tomioka Y, et al. Office closure of eardrum perforation with fibrin glue (in Japanese), Otolaryngol Head Neck Surg (Tokyo) 1989;61:1117-1122, which has little risk of sensorineural hearing loss. We tried bilateral same day surgery using this technique and evaluated its outcome., Methods: Of 86 cases with bilateral perforated chronic otitis media that we treated between 1995-1997, 25 cases underwent bilateral same day surgery. Bilateral SUMs was performed on seven patients, SUM and CMT on 16 patients, and bilateral CMTs on two patients., Results: Closure of perforation was successful in 18 patients (72%) on both sides and in seven patients (28%) on one side. Postoperative air-bone gap of less than 20 dB was achieved in 15 cases (60%) on both sides and in 23 cases (92%) on one side., Conclusion: Bilateral same day surgery for bilateral perforated chronic otitis media is possible if the operative indications are considered.