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Pars tensa retraction pockets in children: treatment by excision and ventilation tube insertion
V Srinivasan1, G Banhegyi, G O'Sullivan
1Department of ENT and Head and Neck Surgery, Arrow Park Hospital, Wirral, UK. cheenu@compuserve.com
Insights
Simple excision and grommet insertion effectively manages tympanic membrane retraction pockets, offering a safe alternative to extensive tympanoplasty. This day case procedure achieved a 74% success rate in a recent study.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Otology
Background:
- Tympanic membrane retraction pockets are common, potentially leading to recurrent infections, ossicular erosion, and cholesteatoma.
- Current management includes surveillance, medical treatment, and various surgical interventions from grommet insertion to tympanoplasty.
Purpose of the Study:
- To evaluate the efficacy and safety of simple excision and grommet insertion for managing tympanic membrane retraction pockets.
- To compare this approach with more extensive surgical procedures like tympanoplasty.
Main Methods:
- A retrospective review of 31 ears in 26 patients undergoing simple excision and grommet insertion as day cases.
- Follow-up ranged from 8 to 34 months (mean 16 months) to assess outcomes and recurrence.
Main Results:
- The procedure demonstrated a 74% success rate (23 out of 31 ears).
- Recurrence of retraction occurred in seven ears, and one ear developed a persistent perforation.
- Patient age, prior grommet insertion, and retraction severity did not significantly impact the outcome.
Conclusions:
- Simple excision and grommet insertion is a safe, efficient, and effective treatment for tympanic membrane retraction pockets.
- This minimally invasive approach can be considered a viable alternative to more complex tympanoplasty procedures.
Abstract:
Tympanic membrane retraction pockets involving the pars tensa are not uncommon in clinical practice. Recurrent infections, ossicular erosion and cholesteatoma are the recognized sequelae. The management options include surveillance, medical treatment and surgery. The surgical procedures range from grommet insertion to extensive tympanoplasty procedures. We report our experience with simple excision and grommet insertion, performed in 31 ears in 26 patients as day cases. The follow-up ranged from 8 to 34 months with a mean of 16 months. The procedure was successful in 23 ears (success rate of 74%). Recurrence of retraction occurred in seven ears and in one ear there was a persistent perforation. Age, previous grommet insertion and severity of retraction did not have a statistically significant influence on the final outcome. We conclude that excision and grommet insertion is a simple, safe and efficient procedure for the management of tympanic membrane retraction pockets and can be considered in preference to extensive tympanoplasty.