Middle ear risk index (MERI) as a prognostic factor for tympanoplasty success in children.

Abstract

Tympanoplasty performed in childhood has been controversial over the years because there is no clarity in determining what prognostic factors lead to surgical success. The objective of this study was to evaluate the effect of the Middle Ear Risk Index (MERI) score on the success of pediatric tympanoplasty. A retrospective case-control study was performed at a tertiary pediatric referral center. A database was created with surgical and clinical records of pediatric patients (<18 years of age) with tympanic membrane perforation, assessed and surgically managed by the same surgical team from January 2012 through March 2018. Mild MERI before tympanoplasty was found to be a protective factor against surgical failure, with an odds ratio of 0.24 (p: 0.002). The odds ratio for severe MERI in unsuccessful tympanoplasty was 5.87, with a p: 0.003, standing out as a risk factor for surgical failure. Presurgical MERI in children may be a useful tool to determine if patients are candidates for tympanoplasty, more aggressive interventions, or if medical treatment before tympanoplasty is necessary to improve prognosis. When facing a high MERI score, parents and family should be advised before surgery about the possibility of tympanoplasty failure.