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Tympanic membrane retraction pocket staging: is it worthwhile?

Musaed Alzahrani1, Issam Saliba

  • 1Division of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, 1560, rue Sherbrooke East, Montreal, Qc, H2L 4M1, Canada.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|July 30, 2013
PubMed
Summary

This study reviewed tympanic membrane retraction pocket staging systems, finding most useful for tracking but lacking consensus for management decisions. A new algorithm prioritizing patient handicap is proposed.

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Area of Science:

  • Otolaryngology
  • Medical Imaging
  • Evidence-Based Medicine

Background:

  • Tympanic membrane retraction pockets (TMRPs) are common otologic conditions.
  • Existing staging systems for TMRPs vary in reliability and clinical utility.
  • Lack of a standardized approach complicates management and follow-up.

Purpose of the Study:

  • To review all reported staging systems for tympanic membrane retraction pockets (TMRPs).
  • To assess the reliability and utility of current TMRP staging systems in clinical practice.
  • To propose a novel management algorithm for TMRPs.

Main Methods:

  • A comprehensive literature search was conducted on Ovid Medline, Pubmed, and Cochrane databases (1963-2012).
  • Included studies focused on retraction pockets, excluding short comments, case reports, and experimental articles.

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  • 60 relevant articles were selected from 756 initial search results.

    • Main Results:

    • Twelve different staging systems for TMRPs were described between 1976 and 2007.
    • TMRPs were categorized into localized pars tensa, generalized pars tensa (atelectasis), and pars flaccida retractions.
    • While most systems aid in monitoring evolution, consensus on management decision-making is absent.

    Conclusions:

    • Effective management of TMRPs necessitates a reproducible, applicable staging system with minimal observer variability.
    • A proposed management algorithm emphasizes patient's functional handicap over topographical descriptions.
    • Further research is needed to validate the proposed algorithm for TMRP management.