To report anatomical and functional results and predictive factors for failure of myringoplasty in children under 6 years of age.

Retrospective study of myringoplasty for tympanic membrane perforation in children under 6 years of age with at least 2 years’ follow-up. Anatomic and audiological results were evaluated before surgery, at 6 weeks (short-term), 12 months (medium-term) and 24 months (long-term). Predictive factors for failure were analyzed.

Forty-seven myringoplasties were included, with a mean patient age of 4.7 ± 0.4 years. Thirty-nine received underlay grafts and 8 received inlay grafts. The rate of success (tympanic closure, and no otitis media with effusion, myringitis of tympanic retraction) at 6 weeks was 77%, and 70% at 24 months: 79% for underlay and 25% for inlay techniques ( P = 0.005). Audiometric thresholds improved significantly, with 96% of patients with air-bone gap ≤ 20 dB at 12 months after surgery, compared to 57% before ( P = 0.002). No risk factors for failure were identified, except use of inlay.

Myringoplasty performed before the age of 6 yielded satisfactory anatomic and functional results, comparable to other pediatric series across all age groups. The underlay cartilage graft technique provided the best long-term outcomes.