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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(04): e624-e629
DOI: 10.1055/s-0042-1742762
Original Research

Evaluation of Recurrence and Hearing Outcome for Inactive Squamosal Disease after Cartilage Strengthening Tympanoplasty

Priyanshi Gupta 
1   Department of Ear, Nose, and Throat, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
,
Digvijay Singh Rawat 
2   Department of Ear, Nose, and Throat and Head and Neck Surgery, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
,
Yogesh Aseri 
2   Department of Ear, Nose, and Throat and Head and Neck Surgery, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
,
P. C. Verma 
2   Department of Ear, Nose, and Throat and Head and Neck Surgery, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
,
B. K. Singh 
2   Department of Ear, Nose, and Throat and Head and Neck Surgery, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
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Abstract

Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage.

Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty.

Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year.

Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air–bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%).

Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.

Keywords

suppurative otitis media - tympanoplasty - ear ossicles


Publication History

Received: 03 September 2021

Accepted: 01 December 2021

Article published online:
22 February 2022

© 2022. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Urík M, Hurník P, Žiak D. et al. Histological analysis of retraction pocket pars tensa of tympanic membrane in children. Int J Pediatr Otorhinolaryngol 2016; 86: 213-217
    CrossrefPubMedGoogle Scholar
  • 2 Rosito LPS, Sperling N, Teixeira AR, Selaimen FA, da Costa SS. The Role of Tympanic Membrane Retractions in Cholesteatoma Pathogenesis. BioMed Res Int 2018; 2018: 9817123
    PubMedGoogle Scholar
  • 3 Mansour S, Magnan J, Haidar H, Nicolas K. Tympanic Membrane Retraction Pockets. In: Mansour S, Magnan J, Haidar H, Nicolas K. editors. Tympanic Membrane Retraction Pocket: Overview and Advances in Diagnosis and Management. Cham: Springer International Publishing; 2015: 29-47
    CrossrefGoogle Scholar
  • 4 Monsell EM. New and revised reporting guidelines from the Committee on Hearing and Equilibrium. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113 (03) 176-178
    CrossrefPubMedGoogle Scholar
  • 5 Olusanya BO, Davis AC, Hoffman HJ. Hearing loss grades and the International classification of functioning, disability and health . Bull World Health Organ 2019; 97 (10) 725-728
    CrossrefPubMedGoogle Scholar
  • 6 OpenEpi Menu [Internet]. [cited 2021 Sep 3]. Available from: https://www.openepi.com/Menu/OE_Menu.htm
    Google Scholar
  • 7 Sharma R. Revised Kuppuswamy's socioeconomic status scale: Explained and updated. Indian Pediatr 2017; 54 (10) 867-870
    CrossrefPubMedGoogle Scholar
  • 8 Marchioni D, Grammatica A, Alicandri-Ciufelli M, Aggazzotti-Cavazza E, Genovese E, Presutti L. The contribution of selective dysventilation to attical middle ear pathology. Med Hypotheses 2011; 77 (01) 116-120
    CrossrefPubMedGoogle Scholar
  • 9 Shunyu NB, Gupta SD, Thakar A, Sharma SC. Histological and immunohistochemical study of pars tensa retraction pocket. Otolaryngol Head Neck Surg 2011; 145 (04) 628-634
    CrossrefPubMedGoogle Scholar
  • 10 Urík M, Hurník P, Žiak D. et al. Immunohistochemical analysis of retraction pocket pars tensa of tympanic membrane in children. Int J Pediatr Otorhinolaryngol 2019; 122: 111-116
    CrossrefPubMedGoogle Scholar
  • 11 Alper C, Olszewska E. Assessment and management of retraction pockets. Otolaryngol Pol 2017; 71 (01) 1-21
    CrossrefPubMedGoogle Scholar
  • 12 James AL, Papsin BC, Trimble K. et al. Tympanic membrane retraction: An endoscopic evaluation of staging systems. Laryngoscope 2012; 122 (05) 1115-1120
    CrossrefPubMedGoogle Scholar
  • 13 Alzahrani M, Saliba I. Tympanic membrane retraction pocket staging: is it worthwhile?. Eur Arch Otorhinolaryngol 2014; 271 (06) 1361-1368
    CrossrefPubMedGoogle Scholar
  • 14 Ramakrishnan Y, Kotecha A, Bowdler DA. A review of retraction pockets: past, present and future management. J Laryngol Otol 2007; 121 (06) 521-525
    CrossrefPubMedGoogle Scholar
  • 15 Cutajar J, Nowghani M, Tulsidas-Mahtani B, Hamilton J. The Natural History of Asymptomatic Deep Pars Tensa Retraction. J Int Adv Otol 2018; 14 (01) 10-14
    CrossrefPubMedGoogle Scholar
  • 16 Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2010; (10) CD001801
    PubMedGoogle Scholar
  • 17 Yung MW. Retraction of the pars tensa–long-term results of surgical treatment. Clin Otolaryngol Allied Sci 1997; 22 (04) 323-326
    CrossrefPubMedGoogle Scholar
  • 18 Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope 2003; 113 (11) 1844-1856
    CrossrefPubMedGoogle Scholar
  • 19 Nankivell PC, Pothier DD. Surgery for tympanic membrane retraction pockets. Cochrane Database Syst Rev 2010; (07) CD007943
    PubMedGoogle Scholar
  • 20 Comacchio F, Mion M, Pedruzzi B. Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma. J Otol 2017; 12 (03) 112-116
    CrossrefPubMedGoogle Scholar
  • 21 Kalra VK, Yadav SPS, Verma M, Singh B, Goel A. Treatment of Tympanic Membrane Retraction Pockets by Excision and Cartilage Tympanoplasty: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2018; 70 (03) 392-394
    CrossrefPubMedGoogle Scholar
  • 22 Kasbekar AV, Patel V, Rubasinghe M, Srinivasan V. The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2014; 66 (04) 449-454
    CrossrefPubMedGoogle Scholar
  • 23 Jesic SD, Dimitrijevic MV, Nesic VS, Jotic AD, Slijepcevic NA. Temporalis fascia graft perforation and retraction after tympanoplasty for chronic tubotympanic otitis and attic retraction pockets: factors associated with recurrence. Arch Otolaryngol Head Neck Surg 2011; 137 (02) 139-143
    CrossrefPubMedGoogle Scholar