Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma

Comacchio, Francesco; Márta, Mészáros; Pedruzzi, Barbara

doi:10.1016/j.joto.2017.04.003

Cited by 5 publications

(7 citation statements)

References 16 publications

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“…19 Comacchio et al suggested that the surgical management of stage II and III retraction pockets with cartilage grafting can prevent cholesteatoma formation in the future. 20 In our study, only 7 cases (14%) had normal ossicular status and the remainder had some degree of ossicular erosion. There were 10 cases (20%) with only the stapes footplate in the middle ear.…”

Section: Discussioncontrasting

confidence: 47%

“…The disadvantage of conchal cartilage use is that it is thinner, and harvest can cause perichondritis. 18,20 These adverse effects were not observed in any of our patients.…”

Section: Discussionmentioning

confidence: 49%

“… 19 Comacchio et al suggested that the surgical management of stage II and III retraction pockets with cartilage grafting can prevent cholesteatoma formation in the future. 20 …”

Section: Discussionmentioning

confidence: 99%

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

Gupta

Rawat

Aseri

et al. 2022

Int Arch Otorhinolaryngol

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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.

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Section: Discussioncontrasting

confidence: 47%

“…The disadvantage of conchal cartilage use is that it is thinner, and harvest can cause perichondritis. 18,20 These adverse effects were not observed in any of our patients.…”

Section: Discussionmentioning

confidence: 49%

See 1 more Smart Citation

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

Gupta

Rawat

Aseri

et al. 2022

Int Arch Otorhinolaryngol

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“…Five studies reported anatomic outcomes with graft success ranging from 60% to 100%. [22][23][24][25][26] None of the included studies compared anatomic success in cases with retraction pockets to cases without. Four studies assessed hearing outcomes 23,25,27,28 ; however, only one of these compared success of cases with retraction pockets to cases without, finding that the presence of retraction pockets did not significantly impact hearing outcomes.…”

Section: Retraction Pocketsmentioning

confidence: 99%

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Gutiérrez

Cabrera

Stout

et al. 2023

Ann Otol Rhinol Laryngol

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Objective: To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. Methods: A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. Results: Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. Conclusion: Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. Level of Evidence: 3B

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“…There are different therapeutic options for this condition, these include conservative or surgical strategies, such as ventilation tube insertion, RP excision with TM reconstruction and canal wall-up or canal wall-down tympanoplasty [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature

Immordino

Salvago

Sireci

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature. Methods Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines. Results The mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air–bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review. Conclusions Based on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.

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Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma

Cited by 5 publications

References 16 publications

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

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

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature

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