Original Investigation |

Frequency-Specific Hearing Outcomes in Pediatric Type I Tympanoplasty

David T. Kent, MD1; Dennis J. Kitsko, DO1,2; Todd Wine, MD3; David H. Chi, MD1,2
[+] Author Affiliations
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
2Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania
3Department of Otolaryngology, Children’s Hospital Colorado, Aurora
JAMA Otolaryngol Head Neck Surg. 2014;140(2):106-111. doi:10.1001/jamaoto.2013.6082.
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Importance  Middle ear disease is the primary cause of hearing loss in children and has a significant impact on language development and academic performance. Multiple prognostic factors have previously been examined, but there is little published data regarding frequency-specific hearing outcomes.

Objective  To examine the relationship between type I tympanoplasty in a pediatric population and frequency-specific hearing changes, as well as the relationship between several prognostic factors and graft retention.

Design, Setting, and Participants  Retrospective medical chart review (February 2006 to October 2011) of 492 consecutive pediatric otolaryngology patients undergoing type I tympanoplasty for tympanic membrane (TM) perforation of any etiology at a tertiary-care pediatric otolaryngology practice.

Interventions  Type I tympanoplasty.

Main Outcomes and Measures  Preoperative and postoperative audiometric data were collected for patients undergoing successful TM repair. It was hypothesized before data collection that conductive hearing would improve at all frequencies with no significant change in sensorineural hearing. Data collected included air conduction at 250 to 8000 Hz, speech reception thresholds, bone conduction at 500 to 4000 Hz, and air-bone gap at 500 to 4000 Hz. Demographic data obtained included sex, age, size, mechanism, location of perforation, and operative repair technique.

Results  Of 492 patients, 320 were excluded; results were thus examined for 172 patients. Surgery was successful for 73.8% of patients. Perforation size was significantly associated with repair success (mean [SD] surgical success rate of 38.6% [15.3%] vs surgical failure rate of 31.4% [15.0%]; P < .01); however, mean (SD) age (9.02 [3.89] years [surgical success] vs 8.52 [3.43] years [surgical failure]; P > .05) and repair technique (medial [73.08%] vs lateral [76.47%] graft success; P > .99) were not. Air conduction significantly improved from 250 to 2000 Hz (P < .001), did not significantly improve at 4000 Hz (P = .08), and there was a nonsignificant decline at 8000 Hz (P = .12). Speech reception threshold significantly improved (20 vs 15 dB; P < .001).

Conclusions and Relevance  This large review found an association of TM perforation size with surgical success and an improvement in speech reception threshold, air conduction at 250 to 2000 Hz, air-bone gap at 500 to 2000 Hz, and worsening bone conduction at 4000 Hz. Patients with high-frequency hearing loss due to TM perforation should not anticipate significant recovery from type I tympanoplasty. Hearing loss at higher frequencies may require postoperative hearing rehabilitation.

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Figure 1.
Distribution of Tympanic Membrane Perforations

Distribution of tympanic membrane perforation as reported by the attending surgeon.

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Figure 2.
Comparison of Frequency-Specific Hearing Changes in Air Conduction, Bone Conduction, and Air-Bone Gap

Mean frequency-specific hearing changes from preoperative to postoperative levels for air conduction, bone conduction, and air-bone gap. Air conduction was measured between 250 Hz and 8000 Hz. Bone conduction was measured between 500 Hz and 4000 Hz. SRT, speech reception threshold.aStatistically significant (P < .05).

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Figure 3.
Preoperative and Postoperative Frequency-Specific Hearing Results in Air Conduction, Bone Conduction, and Air-Bone Gap

Mean hearing levels reported per specific frequency. A, Preoperative and postoperative levels in air conduction. B, Preoperative and postoperative levels in bone conduction. C, Preoperative and postoperative levels in air-bone gap.aStatistically significant (P < .05).

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