Comparative analysis of moderate and severe tympanic membrane retractions in children and adults

Owing to the limited literature demonstrating the correlation between the degree of severity of retractions and the degree of hearing loss in children and adults, the study aimed to compare the differences in the location, the severity, and the air-bone gap (ABG) of tympanic membrane (TM) retractions in children and adults.

Cross-sectional study, in a tertiary hospital. Consecutive patients with moderate or severe TM retractions (661 ears) between August 2000 and January 2019 were evaluated. The average age (mean ± standard deviation) was 11.7 ± 3.3 years among pediatric patients (42.4%) and 46.4 ± 5 years among adults (57.6%). Video-otoscopy and pure tone audiometry were performed in all patients. The main outcome measures were the locations of retractions, their prevalence, and their severity; ABG thresholds measured at the 4-frequency pure-tone average (PTA).

The prevalence of pars flaccida (PF) retractions was higher in adults, while that of pars tensa (PT) was higher in children (p = 0.00). The degree of severity was similar between children and adults for isolated PF and PT retractions (p = 0.37 and p = 0.10, respectively). Effusion was similar in children (27.8%) and adults (33.3%). The median decibel hearing level (dB HL) (minimum-maximum) of the ABG PTA was 13.75 dB (0-57.5 dB HL) in children and 13.75 dB (0-58.7 dB) in adults (p = 0.48). There was no difference in the size of the ABG PTA between children and adults (p = 0.71), and in ABG size for isolated PF retractions (p = 0.14), PT retractions (p = 0.35), and association of PF and PT retractions (p = 0.56).

PT retractions were more prevalent in children and PF retractions in adults. There was no difference between the two groups based on the severity of the retraction. The size of the air-bone gaps was similar in children and adults.