Pars tensa retractions without cholesteatoma in children: predictors for ossicular chain destruction, air conduction thresholds, and postoperative retractions.

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.

Predictors for sensorineural hearing loss in patients with tubotympanic otitis, cholesteatoma, and tympanic membrane retractions.

OBJECTIVE: To determine predicting value of otitis type, age, gender, ear suppuration, disease duration, mucosal changes, cholesteatoma spreading, labyrinthine fistula, size, localization of tympanic membrane perforation, type and stage of its retraction and ossicular chain disruption with sensorineural hearing loss in patients with tubotympanic otitis, cholesteatoma, and tympanic membrane retractions. STUDY DESIGN: Retrospective case review study. SETTING: Tertiary referral center. PATIENTS: Approximately 264 adult patients with unilateral chronic ear disease, 60 adult patients with tympanic membrane retractions, 78 with cholesteatoma, and 126 with tubotympanic otitis. INTERVENTIONS: Otomicroscopy, pure tone audiometry, impedancemetry were carried out preoperatively. Wall up, wall down tympanoplasty, or two-stage surgery was applied depending on pathology. MAIN OUTCOME MEASURE: Bone conduction thresholds for 512 to 4,096 Hz. RESULTS: Mean values of bone conduction thresholds for frequencies 512 to 4,096 Hz were significantly higher in otitis groups than in healthy ears (p = 0.000), without differences between the groups. Ossicular disruption correlated with sensorineural hearing loss in cholesteatoma and tubotympanic otitis for all frequencies; long incus process destruction in tubotympanic ears showed strong negative correlation with sensorineural hearing loss for 512 to 2,048 Hz (linear regression coefficient, intercept was -2.84, -2.48, and -2.41; p = 0.0024, 0.0207, and 0.0076, respectively). Perforation size correlated with sensorineural hearing loss for 512 to 2,048 Hz in tubotympanic otitis (Log regression p = 0.0008, 0.0252, and 0.0267; odds ratio, 1.13, 1.11, and 1.06). Atelectasis correlated with sensorineural hearing loss for 4,096 Hz (p = 0.022). CONCLUSION: Predictors for sensorineural hearing loss in chronic otitis are otitis itself, age, ossicular disruption, especially of long incus process, extensive labyrinthine fistula, perforation size, and type of retraction.