Management Algorithm for Tympanic Membrane Retraction Pockets A New Concept for Treatment
/ 0
- Details
- Category: Vol. 84, September 2016
- Hits: 585
Management Algorithm for Tympanic Membrane Retraction Pockets A New Concept for Treatment, ESSAM FATHY, WAEL A. AL-ZAMIL and SAID ABD EL-MONEN
Abstract
Background: The treatment of retraction pockets of tympanic membrane, whether surgical or non-surgical, is highly variable amongst otologists. It was recognized that producing a guideline on aпу surgical condition based on high level of evidence is difficult. Management decisions and procedures used in the treatment of retraction pockets depends on the functional and anatomic condition of the ear, but still continue to be debatable with multiple controversies.
Aim of the Work: The purpose of this study is to construct a management algorithm for retraction pockets.
Material and Methods: 75 ears of 68 patients had been followed-up since March 2008 till April 2015. 52 children and 16 adults with ages ranging from 7 to 53 years were included in the study. Watchful waiting was performed in 12 ears, T-tube insertion in 18 ears and cartilage tympanoplasty with other surgical details were done in 46 ears.
Results: Watchful waiting in 12 ears showed stationary pathology in 9 patients throughout the study period, with 3 patients suffered progression of the pocket for which T-tube insertion was done. Observations revealed stationary pathology on watchful waiting in 75%, and 33.3% of cases after T-tube insertion which improved to 71.4% after re insertion of tubes, and 85.7-100% of patients after cartilage tympanoplasty and other surgical procedures for different types of pockets. Further follow-up revealed that, in a substantial number of T-tube patients the disorder tended to recur and required further interventions. The results after cartilage tympanoplasty were most stable. Conclusion: Management of retraction pockets should be tailored individually for every patient depending on precise grading of the pocket and compulsory regular follow-up to pick up any progression and to put the patient in his proper level of management inside the management scale.