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Surgical Management of Retraction Pockets: Does Mastoidectomy have a Role?
Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature.
Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty.
Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status.
Results This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (p > 0.5).
Conclusion Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets.
Keywordstympanic membrane - mastoidectomy - tympanoplasty - middle ear - ossiculoplasty - otitis media
Received: 10 April 2019
Accepted: 28 February 2020
24 April 2020 (online)
© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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- 1 Stangerup SE, Tos M, Arnesen R, Larsen P. A cohort study of point prevalence of eardrum pathology in children and teenagers from age 5 to age 16. Eur Arch Otorhinolaryngol 1994; 251 (07) 399-403
- 2 Maw AR, Hall AJ, Pothier DD, Gregory SP, Steer CD. The prevalence of tympanic membrane and related middle ear pathology in children: a large longitudinal cohort study followed from birth to age ten. Otol Neurotol 2011; 32 (08) 1256-1261
- 3 Nankivell PC, Pothier DD. Surgery for tympanic membrane retraction pockets. Cochrane Database Syst Rev 2010; (07) CD007943
- 4 Sadé J. Retraction pockets and attic cholesteatomas. Acta Otorhinolaryngol Belg 1980; 34 (01) 62-84
- 5 Sadé J. Atelectatic tympanic membrane: histologic study. Ann Otol Rhinol Laryngol 1993; 102 (09) 712-716
- 6 Borgstein J, Gerritsma TV, Wieringa MH, Bruce IA. The Erasmus atelectasis classification: proposal of a new classification for atelectasis of the middle ear in children. Laryngoscope 2007; 117 (07) 1255-1259
- 7 Cassano M, Cassano P. Retraction pockets of pars tensa in pediatric patients: clinical evolution and treatment. Int J Pediatr Otorhinolaryngol 2010; 74 (02) 178-182
- 8 Charachon R, Barthez M, Lejeune JM. Spontaneous retraction pockets in chronic otitis media medical and surgical therapy. Ear Nose Throat J 1992; 71 (11) 578-583
- 9 Kasbekar AV, Patel V, Rubasinghe M, Srinivasan V. The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2014; 66 (04) 449-454
- 10 Blaney SP, Tierney P, Bowdler DA. The surgical management of the pars tensa retraction pocket in the child--results following simple excision and ventilation tube insertion. Int J Pediatr Otorhinolaryngol 1999; 50 (02) 133-137
- 11 Srinivasan V, Banhegyi G, O'Sullivan G, Sherman IW. Pars tensa retraction pockets in children: treatment by excision and ventilation tube insertion. Clin Otolaryngol Allied Sci 2000; 25 (04) 253-256
- 12 Dispenza F, Bennici E, Bianchini S. et al. Fat plug myringoplasty: Analysis of a safe procedure for small tympanic perforations. EuroMediterranean Biomedical Journal 2015; 10: 87-92
- 13 Dispenza F, Battaglia AM, Salvago P, Martines F. Determinants of Failure in the Reconstruction of the Tympanic Membrane: A Case-Control Study. Iran J Otorhinolaryngol 2018; 30 (101) 341-346
- 14 Trinidade A, Page JC, Dornhoffer JL. Therapeutic Mastoidectomy in the Management of Noncholesteatomatous Chronic Otitis Media: Literature Review and Cost Analysis. Otolaryngol Head Neck Surg 2016; 155 (06) 914-922
- 15 Shew MA, Muelleman T, Villwock M. et al. Therapeutic Mastoidectomy Does Not Increase Postoperative Complications in the Management of the Chronic Ear. Otol Neurotol 2018; 39 (01) 54-58
- 16 McGrew BM, Jackson CG, Glasscock III ME. Impact of mastoidectomy on simple tympanic membrane perforation repair. Laryngoscope 2004; 114 (03) 506-511
- 17 Albu S, Trabalzini F, Amadori M. Usefulness of cortical mastoidectomy in myringoplasty. Otol Neurotol 2012; 33 (04) 604-609
- 18 Agrawal A, Bhargava P. Comparative Evaluation of Tympanoplasty with or Without Mastoidectomy in Treatment of Chronic Suppurative Otitis Media Tubotympanic Type. Indian J Otolaryngol Head Neck Surg 2017; 69 (02) 172-175
- 19 Mishiro Y, Sakagami M, Kondoh K, Kitahara T, Kakutani C. Long-term outcomes after tympanoplasty with and without mastoidectomy for perforated chronic otitis media. Eur Arch Otorhinolaryngol 2009; 266 (06) 819-822
- 20 Ruhl CM, Pensak ML. Role of aerating mastoidectomy in noncholesteatomatous chronic otitis media. Laryngoscope 1999; 109 (12) 1924-1927
- 21 Dispenza F, Cappello F, Kulamarva G, De Stefano A. The discovery of stapes. Acta Otorhinolaryngol Ital 2013; 33 (05) 357-359