The influence of ventilating tubes on the surgical treatment of atelectatic ears

Tympanic membrane retraction pocket staging: is it worthwhile?

Our objectives were to review all reported staging systems of tympanic membrane (TM) retraction pockets (RP) and to report their reliability and utility to our daily clinical practice in terms of follow-up and decision making in the management of RP. We aim to propose a new management algorithm of TMRPs. We conducted a thorough research on Ovid Medline, Pubmed and Cochrane databases for English and French languages studies published between 1963 and 2012 on the retraction pocket. Studies were excluded if it were a short comments, photo clinical cases, experimental studies or round table articles. Cholesteatoma was not included in keywords, since it is considered as an advanced pathological entity with different staging and management approaches. We included 60 of 756 articles that met our inclusion criteria. Sadé and Berco proposed the first staging system of RP in 1976, while the last one was described by Borgstein et al. in 2007. From 1976 to 2007, 12 different staging systems have been described for tympanic membrane retractions. There are three broad categories of TMRPs: localized retractions of the pars tensa, generalized retractions of the pars tensa (atelectasis) and retraction of the pars flaccida. Most of the described staging systems are useful for following up the evolution of retractions over time. However, no consensus was found concerning the decision making in its management. In conclusion, proper management of TMRPs requires a reproducible, easily applicable staging system with low inter- and intra-observer variability. We propose a management algorithm that considers the functional handicap of the patient rather than the topographic description of the TM.

The prevalence of tympanic membrane and related middle ear pathology in children: a large longitudinal cohort study followed from birth to age ten

OBJECTIVE

To record with video-otoscopy the appearance of the tympanic membranes of a cross section of children aged 9 to 10 years.

STUDY DESIGN

Cross-sectional study nested within an established longitudinal study of childhood development, the Avon Longitudinal Study of Parents and Children.

SETTING

South West England, U.K.

PARTICIPANTS

Approximately 6908 of 7261 children with ages ranging from 105 to 140 months born between April 1, 1991, and December 31, 1992, were examined by trained technicians with video-otoscopy.

MAIN OUTCOME MEASURES

Two photographs were taken of each child's tympanic membranes to show the features of the pars tensa and the pars flaccida.

RESULTS

In just less than three quarters of the children, both ears were normal. Retraction of the pars flaccida was present in 9.6% of children, and that of the pars tensa was present in 7.9%. Most of these changes were mild with few severe retractions. There were 15 cases of overt or suspected cholesteatoma.

CONCLUSION

The tympanic membrane changes reflect most of the middle ear disease seen in 9- to 10-year-old children. The prevalence is low, and few children have serious disease at this stage.

Canalplasty for chronic tympanic membrane atelectasis

PURPOSE

Canalplasty to prevent accumulation of squamous debris has been proposed as an alternative to tympanoplasty for the treatment of tympanic membrane atelectasis and early cholesteatoma. The goal of this article is to report our experience with canalplasty for the treatment of advanced middle ear atelectasis.

MATERIALS AND METHODS

A retrospective review was performed on all patients that underwent tympanoplasty or canalplasty at the University of Florida since 1992. Eight ears (seven patients) with severe atelectasis were found to have been treated with canalplasty (without middle ear reconstruction) to marsupialize the retraction pockets.

RESULTS

Follow-up was conducted at an average of 22 months. Four ears required repeat surgical intervention after an average of 12 months: three required canal wall down mastoidectomies for cholesteatoma, and a tympanoplasty was necessary in one case for persistent perforation. Four ears not requiring revision were without cholesteatoma or perforation at an average follow-up time of 26 months. Mean audiometric thresholds were stable or improved, irrespective of the need for revision surgery.

CONCLUSIONS

Canalplasty may be an alternative for the treatment of atelectasis in selected patients; however, close follow-up after surgery is necessary because of the potential for progression to cholesteatoma.

The surgical treatment of atelectatic ears and retraction pockets in children and adults

Eighty-four ears which underwent tympanoplasty because of an atelectasis of the tympanic membrane were followed up. Thirty-six involved children (4-13 years old). On the average, 50-55 months of postoperative follow-up showed that atelectasis, once operated, shared the same pattern and prognosis in the children as in the adults.

The effect of mastoid surgery on atelectatic ears and retraction pockets

Forty children and 53 adults with a total of 111 atelectatic ears were operated on and followed up. Eight-four ears underwent tympanoplasty, while 27 ears underwent both a tympanoplasty and a mastoid operation. There were no statistically significant differences between the two operation groups as far as their age groups and the extent of the disease present. After follow-up of over 4 years, aeration of the middle ear was found to be better in the tympanoplasty group alone when compared with ears with also had mastoid operations.