Retraction pockets of pars tensa in pediatric patients: clinical evolution and treatment

Objective: To assess outcome in pediatric patients after treatment for retraction pockets of pars tensa in relation to retraction grade, site, occurrence of complications, and patient age. Methods: Outcomes in 45 ears of 37 children medically or surgically treated for retraction pockets were compared to a control group of 40 untreated children over a follow-up period of at least 24 months. Grade I and II retractions were treated with medical therapy or ventilation tube insertion; in III or IV grade retractions, excision and tympanic reinforcement with cartilage grafting and in some cases ossiculoplasty were performed. Results: Medical treatment or ventilation tube insertion resolved grade I and II retractions in 94% of cases. In grade III or IV retractions the anatomic success rate was 75.8%. Normal hearing (air–bone gap <10 dB) was restored in 31 (68.8%) cases. Surgical failures and complications (recurrence, tympanic membrane perforation, progression to cholesteatoma) were higher in posterior retractions. In the control group, only 35% of retractions healed spontaneously; in the remaining cases the condition progressed to more serious retractions or complications. Conclusion: A wait and see approach or conservative therapy is indicated only in mild-to-moderate retraction pockets owing to their benign prognosis. Pocket excision and tympanic reinforcement are absolutely indicated in advanced retractions with complications and/or bilateral conductive hearing loss to avert progression to more serious pathologies.