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Pars tensa retractions without cholesteatoma in children: predictors for ossicular chain destruction, air conduction
Snezana Dragoljub Jesic1, Lejla Hilmo Rovcanin, Ognjen Djordjije Jovicevic
1*School of Medicine, University of Belgrade, Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia; †Clinic for Children Diseases, Department of Otorhinolaryngology, Clinical Centre of Montenegro, Podgorica, Montenegro; and ‡Centre for Endocrine Surgery, Clinic for Endocrinology, Clinical Centre of Serbia, Belgrade, Serbia.
Insights
Attic retraction predicts ossicular defects in children with pars tensa retractions. Cartilage grafts are more effective than fascia grafts for successful tympanic membrane repair.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Surgical Outcomes
Background:
- Pars tensa retractions are common in children and can lead to ossicular chain damage.
- Understanding predictors of ossicular destruction and graft success is crucial for surgical planning.
Purpose of the Study:
- To determine the predictive value of preoperative factors for ossicular destruction in pediatric pars tensa retractions.
- To identify predictors of successful tympanic graft outcomes after surgery.
Main Methods:
- Prospective case series of 48 children without cholesteatoma.
- Evaluated pars tensa retraction stage, attic retraction, and air conduction thresholds.
- Surgical interventions included ventilation tube insertion with or without fascia or cartilage grafts.
Main Results:
- Attic retraction significantly predicted combined ossicular defects (long incus process and stapes superstructure).
- Cartilage grafts showed better outcomes in preventing graft retraction compared to fascia grafts.
- Fascia graft outcomes were negatively predicted by the stage of pars tensa retraction.
Conclusions:
- Surgical exploration of ossicles is warranted even in lower stages of pars tensa retraction due to potential defects.
- Combined retractions are associated with combined ossicular defects.
- Cartilage grafts appear more suitable for tympanic membrane reconstruction in this pediatric population.
Objective:
Determine predictive values of preoperative stages of pars tensa retractions, coexisting attic retraction and preoperative air conduction for ossicular destruction in isolated and combined pars tensa retraction, and predictors for successful tympanic grafts after surgery.
Study Design:
Prospective case series study.
Settings:
Tertiary referral center.
Patients:
Forty-eight children ears without cholesteatoma were included in the study: 23 with isolated pars tensa retraction (median age, 11), 25 with combined pars tensa and attic retractions (median age, 13).
Intervention(S):
Otomicroscopy, pure tone audiometry, and impedancmetry were carried out preoperatively. Three surgical procedures for isolated retractions were used: ventilation tube insertion alone or together with fascia graft or cartilage graft. Two surgical procedures for combined retractions were used: ventilation tube insertion alone and with cartilage graft.
Main Outcome Measures:
Incidence of ossicular destruction, postoperative retraction of the grafts.
Results:
Stage of pars tensa retraction and preoperative air conduction thresholds do not predict long incus process defect in isolated group. Coexistence of an attic retraction predicts combined, long incus process and stapes superstructure defect (Chi = 3.943, p = 0.047, OR = 12.00). Retractions of grafts are predicted by mode of surgery, favoring cartilage graft (isolated group: Chi = 4.306, p = 0.0372,OR = 4.69; combined group Chi = 4.7836, p = 0.0287, OR = 0.1364). Stage of pars tensa retraction predicts poor outcome of fascia graft (Chi = 4.5347, p = 0.0332, OR = 12.00).
Conclusion:
Absence of correlation between stage of pars tensa retraction and air conduction thresholds with ossicular defects justifies surgical exploration of the auditory ossicles, even in lower stages of retraction. Combined ossicular defect is expected in combined retractions. The usage of cartilage graft proved to be more appropriate.
