This paper presents the largest series of pre-school age children undergoing tympanoplasty compared with older children. The authors have collected much prospective data on 259 children undergoing 284 surgeries so were able to perform multivariate analysis. The age groupings of two to four years, five to seven years and 8-13 years were analysed separately to look for predictors of success / failure.
The very young children were shown to have a five-fold greater risk of re-perforation compared with the oldest age group even in the relatively short follow-up of (median) seven months.
The authors argue that despite the improvement in quality of life and modest hearing gains, the risk of graft failure and need for revision surgery are too high so surgery should be delayed if at all possible.