Tympanic membrane retraction: An endoscopic evaluation of staging systems

Area of Science:

• Otolaryngology
• Pediatric Audiology
• Medical Imaging

Background:

• Tympanic membrane (TM) retraction is common in children with cleft palate.
• Accurate assessment of TM retraction is crucial for monitoring hearing health.
• Existing staging systems for TM retraction have variable reliability.

Purpose of the Study:

• To evaluate the inter- and intraobserver variability of different tympanic membrane (TM) retraction staging systems using otoendoscopy in children at risk of retraction from cleft palate.
• To compare the stage of TM retraction with hearing levels.
• To propose optimal characteristics for monitoring TM retraction via endoscopy.

Main Methods:

• A cross-sectional study involving endoscopic images of 245 tympanic membranes (TMs) from children with cleft palate (mean age, 13.0 years).
• Six observers assessed pars tensa and pars flaccida retraction using Sade, Erasmus, and Tos staging systems on two occasions.
• Intra- and interobserver agreements were calculated, and TM retraction extent was correlated with hearing thresholds, excluding TMs with effusion, tubes, or perforation.

Main Results:

• 44% of TMs showed pars tensa and/or flaccida retraction.
• Intraobserver agreement was fair to moderate (kappa = 0.3-0.37), and interobserver agreement was slight to moderate (0.18-0.41).
• No significant correlation was found between hearing threshold and retraction stage, although isolated tensa retraction onto the promontory increased hearing threshold more than incus involvement (P = .02).

Conclusions:

• Endoscopic imaging offers objective TM retraction records, but current staging systems lack satisfactory reliability for these images.
• The correlation between TM retraction stage and hearing threshold is poor, limiting clinical utility.
• Modifications to retraction assessment methods are proposed to enhance validity and clinical relevance.