The clinical observation and evaluation of tympanic membrane retracton pockets

ABSTRACT Objective: Studies involving clinical follow-up of retraction pockets (RP) are available in the literature, but are not sufficient. In general, treatment approaches vary and the results vary. In this study, it is aimed to provide practical benefit and to contribute to the literature by evaluating our clinical approaches with the follow-up of such patients and theoretical benefit in elucidating this pathology. Material and Methods: In this study, 121 ears of 80 patients who applied to Dicle University ENT clinic between 2016-2019 and whose RP was detected as a result of the examination were included. In 20 of the ears, both Pars tensa (PT) and Pars flaksida (PF) had RP. 101 of the ears had only pars tensada RP. Sade (1976) staging was used for pars tensa RP and Tos (1987) staging was used for PF RP. Our study was performed prospectively. A total of 51 ears with pars tensa RP and 12 ears with pars flaksida RP did not undergo any procedure. 70 ears with pars tensa RP and 8 ears with pars flaksida RP underwent at least one of several operations. Audiometry, Eustachian dysfunction test and Eustachian Tube Dysfunction Questionnaire (ETDQ-7) were performed at the first admission and follow-up. Findings: When pars tensa RP phase hearing loss is analyzed; There was no statistically significant difference between normal timpanic membrane and stage 1 PT RP in terms of hearing, whereas statistically significant loss was observed between PT RP stage 2, 3, 4 and normal membrane. Statistically significant stage progression was detected in 51 ears followed by pars tensa RP at the end of the follow-up period (21.98 ± 2.27 months). There was no statistically significant change in the stage of follow-up in 12 ears with pars flaksida RP and followed only (22.42 ± 2.42 months). In 23 ears underwent pars tensa RP and cartilage reinforcement tympanoplasty, no recurrent RP was detected at the end of follow-up period (21.74 ± 2.26 months). Pars tensa RP and Goode T tube applied 10 ears (21.50 ± 2.01 months) and with type 1 paparella VT applied 24 ears (22.04 ± 2.11 months) at the end of follow-up was not statistically significant improvement in terms of progression. Balloon tuboplasty was performed in 13 ears (9 ears Paparella VT, 4 ears cartilage reinforcement TP) additionally and there was a statistically significant improvement at the end of the follow-up period (22.85 ± 1.21 months). Conclusion: If ears with PT RP will not be operated, they should be followed at short intervals. The clinical course of pars flaksida RP's is slower than that of PT RP. Pars tensa RP is an effective method of cartilage reinforcement TP in the ears. Type 1 Paparella VT and T tube cannot provide complete cure although it stops disease progression in PT RP. In pars tensa RP's, balloon tuboplasty performed as an additional procedure to type 1 Paparella VT was found to be more effective than type 1 Paparella VT. Keywords: Retraction Pocket, Pars Tensa, Clinical Follow-up, Ventilation Tube, T Tube, Balloon Tuboplasty, Cartilage Tympanoplasty