Tympanoplasty for the anterior-superior perforation in children.

Anterior-superior perforations of the tympanic membrane have proven more difficult to repair than other perforations, and many investigators have found such repairs to be problematic. We report a technique in which the tympanic membrane is released from the malleus, and the graft is placed medical to the remnant, lateral to the malleus, and medial to the tympanomeatal flap. In a series of 42 cases the short-term surgical success rate (represented by an intact graft at 6 months) was 98%, with 95% of ears remaining free of reperforation to the end of follow-up. Postoperatively, 90% of children had an air-bone gap of 20 dB or less and 100% of children had an air-bone gap of 30 dB or less. Eighty-seven percent of subjects demonstrated a speech reception threshold (SRT) of 20 dB or better, whereas 100% of subjects demonstrated an SRT of 30 dB or better. These results compare favorably with those reported at this institution for repair of perforations of any quadrant in children, and those of other investigators for anterior superior perforations in adults.