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Transmeatal excision of pars tensa retraction pockets with simultaneous ventilation tube insertion in children: a
Gábor Ráth1, Imre Gerlinger, Zsuzsanna Csákányi
1Pediatric ENT Department, Medical School, Pécs University, Pécs, Hungary. gaborrath@freemail.hu
Abstract:
Grade II and III (according to Sadé's classification) retraction pockets (RPs) in 40 ears of 30 children were excised transmeatally with simultaneous ventilation tube insertion. At a mean follow-up of 16.1 months, an intact tympanic membrane and mild, grade I retractions not requiring treatment were observed in 32 ears (80%). The mean air-bone gap had decreased from 22.4 to 9.7 dB. Two residual perforations and six recurrent grade II RPs were detected, all these eight ears undergoing further surgery. The second surgery solved both of the residual perforations and four of the six grade II recurrences. The age of the children did not influence the success rate, whereas bilateral pathology, a higher grade and more extensive RPs were associated with a higher rate of unsuccessful cases. A staging system is introduced to ease the selection of candidates with a good prognosis for this procedure.
Insights
Transmeatally excising retraction pockets (RPs) in children significantly improved tympanic membrane health and reduced air-bone gaps. While 80% had successful outcomes, factors like pathology extent influenced recurrence rates.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Auditory Health
Background:
- Retraction pockets (RPs) are common sequelae of otitis media.
- Advanced RPs (Grade II and III) can lead to cholesteatoma and hearing loss.
- Surgical intervention is often considered for significant RPs.
Purpose of the Study:
- To evaluate the efficacy of transmeatal excision with ventilation tube insertion for Grade II and III RPs.
- To assess the long-term outcomes and success rates of this surgical approach.
- To identify factors influencing surgical success and recurrence.
Main Methods:
- Retrospective analysis of 40 ears in 30 children with Grade II and III RPs.
- Transmeatal excision of RPs combined with ventilation tube insertion.
- Mean follow-up of 16.1 months, assessing tympanic membrane integrity and hearing levels.
Main Results:
- 80% of ears achieved an intact tympanic membrane with mild, non-progressive RPs.
- Mean air-bone gap significantly reduced from 22.4 dB to 9.7 dB.
- Factors associated with poorer outcomes included bilateral pathology, higher RP grade, and extensive RPs.
Conclusions:
- Transmeatal excision with ventilation tube insertion is an effective treatment for pediatric Grade II and III RPs.
- A proposed staging system may aid in selecting patients with a favorable prognosis.
- Further surgical management is effective for residual perforations and recurrent RPs.
