Introduction Although attic retractions have previously been classified into Grades 0 through IV, it is often not possible to assign attic retraction pockets into a single specific category. The present study describes an improved classification system based on otoscopic and endoscopic visualization of the retraction pocket fundus, the ossicular status in the attic, degree of scutal erosion, and the presence or absence of cholesteatoma. Materials and Methods One hundred and fifty‐four patients (200 ears) with different grades of attic retraction pockets who were seen by a tertiary referral otology center between August 2015 and July 2018 were selected for this study. Observations The new classification system (Grades I, IIa, IIb, IIIa, IIIb, IIIc, IVa, IVb, IVc, and V) was applied to these retraction pockets. Pure tone audiometry was obtained. Results All attic retraction pockets could be classified precisely using the new classification system. Forty‐four of 200 (22%) of ears showed Grade I Attic retraction, 18 ears showed Grade IIa (9%), 14 showed Grade IIb (7%), 28 showed Grade IIIa (14%), 12 showed IIIb (6%), 20 showed Grade IIIc (10%), 16 showed grade IVa (8%), 12 showed grade IVb (6%), 28 showed grade IVc (14%), and eight showed grade V (4%) attic retraction pockets. Grades I, IIa, IIb, IIIa, and IVa had no significant hearing loss. Average hearing loss was 42 dB and 52 dB in Grades IIIb and IIIc, 44 dB and 58 dB in Grades IVb and IVc, and 61 dB in Grade V. Level of Evidence 5 Laryngoscope, 130: 2034–2039, 2020
Results: 142334 people were screened in the year 2014 in which 10248 suffered from hearing loss. Prevalence of hearing loss was 7.2%. 9310 patients were managed conservatively. Surgery was performed in 506 cases and hearing aid was provided to 432 cases. Conclusion: This study emphasizes that through the introduction of concept of ear care workers, a large number of unprivileged patients with treatable causes of hearing loss can be provided with appropriate, cost effective and early treatment.
Results: 142334 people were screened in the year 2014 in which 10248 suffered from hearing loss. Prevalence of hearing loss was 7.2%. 9310 patients were managed conservatively. Surgery was performed in 506 cases and hearing aid was provided to 432 cases. Conclusion: This study emphasizes that through the introduction of concept of ear care workers, a large number of unprivileged patients with treatable causes of hearing loss can be provided with appropriate, cost effective and early treatment.
Background Decades of clinical observation have led our subspecialty team to suspect that negative nasopharyngeal pressure is associated with attic retraction pocket formation. Furthermore, LaPlace's law, which states that the pressure within a sphere varies with the inverse of the radius, provides the dynamic explanation for why the attic area of the tympanic membrane tends to retract more frequently than the pars tensa. Methods The attic retraction pockets of 154 patients were classified into grades of severity (grades I–V). Impedance audiometry of middle-ear pressure was measured in the resting state, and after sniffing, swallowing and the Valsalva manoeuvre. Results Negative nasopharyngeal pressure (sniffing) caused a diminution of middle-ear pressure of −5 daPa on average in normal ears, and of −24 daPa to −45 daPa for tympanic membranes with attic retraction pockets of grade I to grade V. Conclusion Attic retraction pockets are associated with greater collapse of middle-ear volume when negative pressure is created in the nasopharynx. LaPlace's law, and the composition of the pars flaccida, suggests an explanation for why the attic region retracts more than the pars tensa.
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