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The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy

INTRODUCTION: Tympanic membrane retraction (TMR) is a relatively common otologic finding. Currently, there is no consensus on the optimal treatment of TMR. Some ENT-surgeons advocate surgical correction while others opt for a watchful-waiting policy. Our aim was to investigate the natural course of...

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Autores principales: Bayoumy, Ahmed B., Veugen, Christianne C.A.F.M., Rijssen, L. Bengt, Yung, Matthew, Bok, Jan-Willem M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737861/
https://www.ncbi.nlm.nih.gov/pubmed/32890292
http://dx.doi.org/10.1097/MAO.0000000000002834
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author Bayoumy, Ahmed B.
Veugen, Christianne C.A.F.M.
Rijssen, L. Bengt
Yung, Matthew
Bok, Jan-Willem M.
author_facet Bayoumy, Ahmed B.
Veugen, Christianne C.A.F.M.
Rijssen, L. Bengt
Yung, Matthew
Bok, Jan-Willem M.
author_sort Bayoumy, Ahmed B.
collection PubMed
description INTRODUCTION: Tympanic membrane retraction (TMR) is a relatively common otologic finding. Currently, there is no consensus on the optimal treatment of TMR. Some ENT-surgeons advocate surgical correction while others opt for a watchful-waiting policy. Our aim was to investigate the natural course of retraction pockets in the posterosuperior quadrant of the pars tensa in a large cohort of patients. METHODS: An observational retrospective cohort study was conducted including patients of all ages with a posterosuperior pars tensa retraction. Primary outcome measure was difference between audiometry at first and last visits. Secondary outcomes were patients’ complaints, otoscopic outcomes (Sade classification), and complications (perforation, ossicular chain damage, and/or cholesteatoma). RESULTS: A total of 71 patients with 81 ears and a median age of 23 years (IQR 14–47) were included. The median duration of follow-up was 64 months (IQR 44–102). The mean air-bone gap at first and last visits was 17.9 dB (SD 11.3) and 15.5 dB (SD 12.9), respectively, with a mean improvement of 2.4 dB (p = 0.08). In 10 ears (12%) the hearing level (air-bone gap) deteriorated with 10 dB or more. Patients who presented with a TMR Sade grade I at first visit had significantly better audiometric outcomes than patients presenting with Sade grade III (p = 0.001). Progression to cholesteatoma occurred in one patient (1%), progression to perforation occurred in five patients (6%), and progression to ossicular chain damage occurred in five patients (6%). CONCLUSIONS: Otoscopic findings and audiometric results remained stable in most TMRs without treatment. Additionally, audiometry did not worsen during last follow-up. Progression to cholesteatoma, perforation, or ossicular chain damage was rare. Shared decision making regarding TMRs should include a discussion of a wait-and-see policy.
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spelling pubmed-77378612020-12-22 The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy Bayoumy, Ahmed B. Veugen, Christianne C.A.F.M. Rijssen, L. Bengt Yung, Matthew Bok, Jan-Willem M. Otol Neurotol Pediatric Otology INTRODUCTION: Tympanic membrane retraction (TMR) is a relatively common otologic finding. Currently, there is no consensus on the optimal treatment of TMR. Some ENT-surgeons advocate surgical correction while others opt for a watchful-waiting policy. Our aim was to investigate the natural course of retraction pockets in the posterosuperior quadrant of the pars tensa in a large cohort of patients. METHODS: An observational retrospective cohort study was conducted including patients of all ages with a posterosuperior pars tensa retraction. Primary outcome measure was difference between audiometry at first and last visits. Secondary outcomes were patients’ complaints, otoscopic outcomes (Sade classification), and complications (perforation, ossicular chain damage, and/or cholesteatoma). RESULTS: A total of 71 patients with 81 ears and a median age of 23 years (IQR 14–47) were included. The median duration of follow-up was 64 months (IQR 44–102). The mean air-bone gap at first and last visits was 17.9 dB (SD 11.3) and 15.5 dB (SD 12.9), respectively, with a mean improvement of 2.4 dB (p = 0.08). In 10 ears (12%) the hearing level (air-bone gap) deteriorated with 10 dB or more. Patients who presented with a TMR Sade grade I at first visit had significantly better audiometric outcomes than patients presenting with Sade grade III (p = 0.001). Progression to cholesteatoma occurred in one patient (1%), progression to perforation occurred in five patients (6%), and progression to ossicular chain damage occurred in five patients (6%). CONCLUSIONS: Otoscopic findings and audiometric results remained stable in most TMRs without treatment. Additionally, audiometry did not worsen during last follow-up. Progression to cholesteatoma, perforation, or ossicular chain damage was rare. Shared decision making regarding TMRs should include a discussion of a wait-and-see policy. Lippincott Williams & Wilkins 2021-01 2020-09-03 /pmc/articles/PMC7737861/ /pubmed/32890292 http://dx.doi.org/10.1097/MAO.0000000000002834 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle Pediatric Otology
Bayoumy, Ahmed B.
Veugen, Christianne C.A.F.M.
Rijssen, L. Bengt
Yung, Matthew
Bok, Jan-Willem M.
The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy
title The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy
title_full The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy
title_fullStr The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy
title_full_unstemmed The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy
title_short The Natural Course of Tympanic Membrane Retractions in the Posterosuperior Quadrant of Pars Tensa: A Watchful Waiting Policy
title_sort natural course of tympanic membrane retractions in the posterosuperior quadrant of pars tensa: a watchful waiting policy
topic Pediatric Otology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737861/
https://www.ncbi.nlm.nih.gov/pubmed/32890292
http://dx.doi.org/10.1097/MAO.0000000000002834
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