Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane.

OBJECTIVES: Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps. METHODS: A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program. RESULTS: 661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20 dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation. CONCLUSION: The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG threshold, only for PT. EVIDENCE LEVEL: 4.

Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane,

Abstract Objectives: Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps. Methods: A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program. Results: 661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation. Conclusion: The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG threshold, only for PT. Evidence level: 4.

Comparative analysis of moderate and severe tympanic membrane retractions in children and adults.

OBJECTIVE: Owing to the limited literature demonstrating the correlation between the degree of severity of retractions and the degree of hearing loss in children and adults, the study aimed to compare the differences in the location, the severity, and the air-bone gap (ABG) of tympanic membrane (TM) retractions in children and adults. METHODS: Cross-sectional study, in a tertiary hospital. Consecutive patients with moderate or severe TM retractions (661 ears) between August 2000 and January 2019 were evaluated. The average age (mean ± standard deviation) was 11.7 ± 3.3 years among pediatric patients (42.4%) and 46.4 ± 5 years among adults (57.6%). Video-otoscopy and pure tone audiometry were performed in all patients. The main outcome measures were the locations of retractions, their prevalence, and their severity; ABG thresholds measured at the 4-frequency pure-tone average (PTA). RESULTS: The prevalence of pars flaccida (PF) retractions was higher in adults, while that of pars tensa (PT) was higher in children (p = 0.00). The degree of severity was similar between children and adults for isolated PF and PT retractions (p = 0.37 and p = 0.10, respectively). Effusion was similar in children (27.8%) and adults (33.3%). The median decibel hearing level (dB HL) (minimum-maximum) of the ABG PTA was 13.75 dB (0-57.5 dB HL) in children and 13.75 dB (0-58.7 dB) in adults (p = 0.48). There was no difference in the size of the ABG PTA between children and adults (p = 0.71), and in ABG size for isolated PF retractions (p = 0.14), PT retractions (p = 0.35), and association of PF and PT retractions (p = 0.56). CONCLUSION: PT retractions were more prevalent in children and PF retractions in adults. There was no difference between the two groups based on the severity of the retraction. The size of the air-bone gaps was similar in children and adults.

Audiometric Pattern in Moderate and Severe Tympanic Membrane Retraction.

OBJECTIVE: To evaluate the audiometric pattern in moderate/severe retractions of the tympanic membrane and correlate it with the severity of the otoscopy findings. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary hospital. PATIENTS: Consecutive patients with moderate or severe tympanic membrane retraction in at least one ear (451 ears) between August 2000 and January 2019, and no surgical history or effusion (mean [standard deviation] age, 32.8 [20.2] yr; 54% female and 42.4% children). INTERVENTION: Pure-tone audiometry. MAIN OUTCOME MEASURES: Air conduction (AC) and bone conduction thresholds, and air-bone gap (ABG) measured at the four-frequency pure-tone average. RESULTS: The median in decibel hearing level (dB HL) (minimum-maximum) of the AC, BC, and ABG were 25 dB HL (0-120 dB HL), 10 dB HL (0-75 dB HL), and 12.5 dB HL (0-55 dB HL), respectively. Seventy-two percent of the ears had an ABG ≤ 20 dB HL. For severity of the retraction of pars flaccida (PF), the AC, bone conduction, and ABG were similar across groups, with a weak correlation. For the pars tensa (PT), there was a global difference in the medians of AC and ABG in terms of the degree of severity, with a moderate correlation. Retraction in PF and PT at the same time was observed in 6 4% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05). CONCLUSION: The ABG pure-tone average median was higher when PT was involved. We found a significant correlation between the retraction severity and worsening of AC and ABG thresholds, only for PT.