Outcome of Overlay versus Underlay in Pediatric Tympanoplasty

Abstract

Objectives:

Determine whether overlay tympanoplasty has equivalent outcome to underlay tympanoplasty in children.

Methods:

A retrospective cohort study was performed. Data from primary tympanoplasties performed between 2005 and 2013 in children ages 2 to 13 years old by a single surgeon at a single pediatric tertiary care institution were reviewed. Outcome reviewed included anatomical success, hearing results and cholesteatoma.

Results:

A total of 104 cases were included; 21 overlay and 83 underlay tympanoplasties. Children having undergone an overlay tympanoplasty were more likely to have an anterior perforation (P = .003); other characteristics were similar between the 2 groups including size of the perforation. The rate of anatomical success was 82% for underlay and 95% for overlay tympanoplasties (odds ratio = 4.41, P = .006). Children having undergone an overlay tympanoplasty had significantly worse hearing results (P = .02) and had an increased rate of post-tympanoplasty cholesteatoma (P = .03). After multivariate analysis controlling for the effect of perforation location and size the odds of anatomical success after overlay tympanoplasty was 2.45 times greater (P = .44) compared to underlay tympanoplasty. Age and craniofacial anomalies were not found to influence the success rate of overlay compared to underlay tympanoplasty.

Conclusions:

In the current series, overlay pediatric tympanoplasty was associated with a higher rate of anatomical success, but worse hearing outcome and increased risk of cholesteatoma. Further, larger studies are needed to define which children benefit from the increased anatomical success rate of overlay tympanoplasty.