Minimally Invasive Repair of Posterior-Superior Retraction Pockets in Children with Lysis of Middle Ear Adhesions

Abstract

Objectives:

(1) Treat adhesive tympanic membrane (TM) retractions in children by lysis of middle ear adhesions during insertion of tympanostomy tubes (TT). (2) Analyze the ability to improve conductive hearing loss and to prevent progression of retraction pockets, incus erosion, and avoid future tympanoplasty.

Methods:

A retrospective review from 2005 to 2013 was performed in 22 ears of 18 patients who were candidates for cartilage tympanoplasty to correct a progressive posterior-superior retraction pocket, with or without incus erosion. Lysis of middle ear adhesions using angled picks was performed through the myringotomy before insertion of a TT. The hypothesis was that the released redundant TM, wrapped around the barrel of the TT to maintain it under tension, could allow regeneration of a healthy tympanic membrane in children.

Results:

TM retractions were elevated and adhesions lysed in 22 ears. Mean age was 11.3 years (range, 4-22 years). Follow-up ranged from 3 to 72 months (mean, 23.2 months). Preoperatively, there were 15 Sade grade III and 7 grade IV atelectatic TMs. Postoperatively, there were 14 without retraction, 6 grade I, 1 grade III, and 1 grade IV TMs. Grade I and nonretracted TMs healed without dimers. Mean AB gap improved from 19.94 to 3.88 dB. Two ears required a revision procedure and a third ear developed a cholesteatoma.

Conclusions:

Lysis of middle ear adhesions through a myringotomy at the time of TT insertion allows for healing of the tympanic membrane, improved hearing, and can be effective in preventing progression of atelectasis and incus erosion in children.