Predictive factors of long-term tympanoplasty outcomes in children with cleft palate.

OBJECTIVE: Identify factors associated with long-term tympanoplasty success in children with cleft palate. METHODS: All tympanoplasty procedures for chronic perforation in children with cleft palate at a single institution were reviewed over a 20-year period. Demographic and clinical characteristics were compared by tympanoplasty outcome - successful sustained repair versus reperforation or tympanostomy tube placement versus need for revision tympanoplasty - with univariate, survival, and multivariate analysis. RESULTS: A total of 50 initial tympanoplasty procedures for chronic perforation between 2004 and 2024 at a single institution met inclusion criteria of patients <18 years with a history of cleft palate, excluding revision and second-sided procedures. The overall success rate of primary tympanoplasty was 78 % with a mean length of follow-up of 5.7 (+/-3.6) years. Significant demographic and clinical predictors were not demonstrated by univariate analysis. However, survival analysis of time to tympanoplasty failure demonstrated differences in duration of successful tympanoplasty for children in which Eustachian tube function could be assessed by the status of the contralateral ear, with a mean time to failure of 10.7 [9.5-12.0] compared to 8.2 [5.3-11.0] years (p = 0.02). Ability to assess the contralateral ear was also associated with a 5.4 (1.1.-26.1) increased likelihood of a successful tympanoplasty outcome. CONCLUSION: The success rate of tympanoplasty in children with cleft palate is lower than would be expected in an adult or non-cleft population, but can still be largely successful at a mean age of <12 years. The ability to assess the contralateral ear may the most important predictive factor in determining success rather than age, cleft type, or other demographic and clinical factors.