Myringoplasty without tympanomeatal flap elevation in children: A systematic review

Objectives: Systematic review of the literature on myringoplasty techniques without tympanomeatal flap elevation in children. Material and methods: A systematic review following PRISMA guidelines reported papers on patients under 18 years of age undergoing myringoplasty for chronic tympanic perforation on a transcanal approach without tympanomeatal flap elevation. Tympanic closure rates and audiometric results were analyzed. Results: Twenty studies were included. Nine reported the butterfly technique, using a microscope or endoscope, with closure rate of 82.3% (246/299), for perforations of various sizes. Ten reported the fat -plug technique, with closure rate of 86.8% (869/1001), mostly for perforations of less than one-third of the tympanum. Both techniques improved audiometric results. Morbidity was very low. The absence of chronic otitis or co-morbidities (contralateral otitis media with effusion, craniofacial malformations, Down?s syndrome) implies that patient selection technique may be necessary to obtain the best results. Conclusion: Fat-plug myringoplasty, for small perforations, and butterfly cartilage myringoplasty seem to be reliable procedures in selected patients, with low morbidity in children. ? 2020 Elsevier Masson SAS. All rights reserved.