Tympanic Membrane Retraction Pocket (original) (raw)
Related papers
Histological analysis of retraction pocket pars tensa of tympanic membrane in children
International Journal of Pediatric Otorhinolaryngology, 2016
Histological and histochemical analysis of retraction pocket of pars tensa of tympanic membrane in children. Identification of morphological abnormalities in comparison with a healthy tympanic membrane as it is described in standard textbook. Identification of signs typical for cholesteatoma and support for a retraction theory of cholesteatoma formation. Study design: A prospective study analysing 31 samples of retraction pockets taken during surgery. Departments: University Hospital, Children's Medical Centre Methods: Samples of retraction pockets were processed by a standard process for light microscopy, stained by haematoxylin-eosin. Van Gieson's stain was used for differential staining of collagen, Verhoeff's stain for elastic fibre tissues, Alcian blue for acidic polysaccharides and PAS (Periodic Acid Schiff) method for basement membrane polysaccharides. Results: The following findings were observed in the samples of retraction pockets: hyperkeratosis (100%), hypervascularisations (100%), subepithelial fragmented elastic fibres (96%), myxoid changes (87%), subepithelial inflammatory infiltration (84%), rete pegs (71%), papilomatosis (71%), intraepithelial inflammatory cellularizations, (48%), intraepithelial spongiosis (16%) and parakeratosis (3%). No basement membrane continuity interruptions were observed. Thickness of retraction pocket, thickness of epidermis, occurrence of rete pegs and frequency of fragmented elastic fibres was higher in a Grade III stage RP than Grade II stage RP (according to Charachon). Conclusion: Morphological abnormalities in the structure of retraction pockets in comparison with a healthy tympanic membrane were described. The changes are typical for a structure of cholesteatoma (these changes are common in matrix and perimatrix), supporting retraction theory of its origin. Our observations show that it is inflammation that probably plays a key role in the pathogenesis of retraction pocket. The frequency of some of the changes increases with the stage of retraction pocket (II-III according to Charachon). Basement membrane continuity interruptions are not typical for retraction pockets.
Tympanic Retraction Pockets: Diagnostic and Therapeutic Aspect
International Journal of Otorhinolaryngology
Background: Retraction pockets represent a form of chronic otitis considered to be a precholesteatomatous stage. This study aims to study the diagnostic and therapeutic aspects of tympanic retraction pockets in the ENT department of the University Hospital Center "Gabriel Touré". Patients and Method: This was a prospective longitudinal study extended over 15 months; from February 1, 2020 to May 31, 2021 from the files of patients received as an outpatient in the ENT and Cervicofacial Surgery department of the CHU Gabriel Touré in Bamako. Were included any patient seen in an outpatient department at the otorhinolaryngology and head and neck surgery department of the CHU Gabriel Touré in Bamako with a pocket of tympanic retraction and who had consented to the study. Data collection was done using a previously established survey form. Data were entered in Word 2016 and analyzed using SPSS software. Results: The prevalence of retraction pockets was estimated at 1.2% of all consultations. The most represented age group was that of (25-39 years), i.e. 25.0%. The average age was 44.91 ± 20.05 years. The extremes of ages were 10 years and 81 years. The female sex was the most represented, at 63.9% with a sex ratio ꞊ 0.6. A history of otitis was present in half of the cases. Tinnitus was the main reason for consultation (50% of cases) followed by hearing loss (25%). The otoendoscopic examination had noted a predominance of lesions on the left (52%) and an attical seat in 30.6% of cases. The pockets were controllable and self-cleaning in all cases, and peelable in 75% of cases (stage I of the weevil classification) and nonpeelable and controllable in 25% of the cases (stage II of weevil). Conductive hearing loss was found in 8.3% of cases, mixed hearing loss in 5.6% of cases and sensorineural hearing loss in 2.8% of cases. CT of the rock was performed in two patients, and showed erosion of the attic wall associated with tissue hypodensity in the attic. Medical treatment based on systemic corticosteroids and nasal decongestant was initiated in all our patients associated with quarterly monitoring for stages I of charachon, i.e. 75% of the workforce. The placement of a tympanostomy tube was performed in 8 patients classified (stage II of charachon) ie (2, 88%). Antroatticotomy associated with reinforcement tympanoplasty was performed in a patient (0,36%).
Indian Journal of Otolaryngology and Head & Neck Surgery, 2018
To assess the role of cartilage tympanoplasty in management of retraction pockets of the pars flaccida. This was a prospective study at a tertiary care centre. Twenty patients having grade III or grade IV retraction pockets were included in the study. Retraction pockets were treated by excision and cartilage tympanoplasty. Findings noted on follow-up were recorded and analysed. Graft was taken up in 18 (90%) cases with residual perforation in 2 (10%) cases. Recurrence of retraction pockets was observed in 6 (30%) cases. Hearing was improved up to 15 dB in 16 (80%) cases. It is concluded that grade III and IV retraction pockets can be well managed by excision and cartilage tympanoplasty.
Tympanic membrane changes in central tympanic membrane perforations
American Journal of Otolaryngology, 2005
The objective of this study was to evaluate the histopathological changes in central tympanic membrane perforations caused by chronic otitis media without cholesteatoma. Materials and methods: Twenty-nine temporal bones from 25 patients (13 male patients and 12 female patients) with central tympanic membrane perforations-18 chronic otitis media with perforation and 11 chronic otitis media with perforation caused by ventilation tubes-and 30 agedmatched normal temporal bones were included in this study. A scale was used to evaluate the extension of the migration of stratified squamous epithelium in the inner surface of the tympanic membrane. The thickness of tympanic membranes was measured halfway between the annular ligament and the perforation and compared with that of the normal bones. The presence of tympanosclerosis and papillary projections of squamous epithelium was also noted. Results: The extension of the migration of stratified squamous epithelium in the inner surface of the tympanic membrane was observed in 11 of the 29 perforations (38%). The thickness of tympanic membranes was significantly different between the perforation groups and the control group. Of the 29 tympanic membranes, 13 (44%) had tympanosclerosis and 8 (28%) revealed papillary projections of squamous epithelium. Conclusions: Our study shows that a central tympanic perforation should not merely be considered as a simple defect. Most of the tympanic membranes showed one or more signs of sequelae or persistent abnormalities such as tympanosclerosis, papillary projections, thickening, and ingrowth without significant differences between the 2 central perforation groups.
The concept of an artificial tympanic membrane
Clinical Otolaryngology, 1984
The concept of an artificial tympanic membrane A review is given of the development of the concept of an artifical tympanic membrane. Starting with homologous tympanic membranes we compared biodegradable collagen materials (homologous and heterologous) and biodegradable synthetic materials, poly-glycolic acid, poly-lactic acid and poly-a-amino acids. As a non-degradable material microporous PTFE and bisphenol-A poly (carbonate) were investigated. It is concluded that either poly-a-amino acid or PTFE with poly-aamino acid maybe a suitable material for an artificial tympanic membrane.
Histopathology of tympanic membranes from patients with ventilation tubes
Auris Nasus Larynx, 2017
To evaluate the histopathologic changes in tympanic membranes (TMs) with ventilation tubes (VTs). Methods: In this retrospective human temporal bone study our overall study group included 4 subgroups of TMs from deceased donors as follows: 24 with a history of VT insertion for chronic otitis media with effusion (COME-VT); 5 with a history of VT insertion for Meniere's disease (MD-VT); 33 without a history of VT insertion for chronic otitis media with effusion (COME); and 14 without a history of VT insertion for Meniere's disease (MD). We classified the extent of migration of the outer keratinized squamous epithelium onto the inner surface of TM perforations and noted the presence and location of tympanosclerosis, of atrophy, of perforation, and/or of cholesteatoma formation. Results: Tympanosclerosis occurred in 14/24 TMs in the COME-VT subgroup; 2/5, MD-VT; 7/33, COME; and 0/14, MD. The VT insertion site was mostly in the anteroinferior (63%) quadrant of the TM; tympanosclerosis occurred more frequently in the posteroinferior (42%) and posterosuperior (33%) quadrants. We found no significant correlation between the location of tympanosclerosis and the VT insertion site (P > 0.05). Atrophy occurred in 7/24 TMs in the COME-VT subgroup; 3/5, MD-VT; 8/33, COME; and 2/14, MD. We found no significant correlation between the location of atrophy and the VT insertion site; however, atrophy was located mostly in the anteroinferior quadrant (one of the most common VT insertion sites) of the TM. Regarding the ingrowth of keratinized epithelium, the mucocutanous junction was detected at any point at the inner surface of the TM in 50% of the specimens. We observed intratympanic cholesteatoma formation in 2/24 TMs in the COME-VT subgroup. Conclusion: TM changes due to VT insertion are more common than previously realized. Meticulous otomicroscopic evaluation of the TM is necessary during tympanomastoidectomies in order to prevent the intratympanic inclusion pearls and squamous epithelial ingrowth to prevent any further cholesteatoma formation.
Tympanic membrane retraction: An endoscopic evaluation of staging systems
The Laryngoscope, 2012
Objectives/Hypothesis: The objectives of this work were to assess inter-and intraobserver variability of different staging systems for tympanic membrane (TM) retraction using otoendoscopy in children at risk of retraction from cleft palate, to compare hearing level with stage of retraction, and to propose optimum characteristics for monitoring TM retraction with endoscopy. Study Design: Cross-sectional study. Methods: Endoscopic images of 245 TMs of children with cleft palate (mean age, 13.0 years) were assessed on two separate occasions by six observers using the Sade and Erasmus staging systems for pars tensa retraction and Tos system for pars flaccida retraction. Intra-and interobserver agreements were calculated. Extent of TM retraction was compared with hearing threshold. TMs with middle ear effusion, tympanostomy tubes, or perforation were excluded. Results: A total of 108 ear drums (44%) were rated as having pars tensa and/or flaccida retraction. Intraobserver agreement was fair to moderate (kappa ¼ 0.3-0.37, P < .001) for the different staging systems and interobserver agreement slight to moderate (0.18-0.41 P < .001). Conductive hearing loss (four-tone average air-bone gap >25 dB HL) was present in 11 ears (15%). No correlation between hearing threshold and retraction stage was found. Isolated tensa retraction onto the promontory increased hearing threshold more than retraction involving the incus (P ¼ .02; analysis of variance). Conclusions: Endoscopic image capture may provide a clear objective record of TM retraction, but current staging systems have unsatisfactory reliability when applied to such images, and retraction stage correlates poorly with hearing threshold. Modification of retraction assessment to improve validity and clinical relevance is proposed.
2015
The finite-element calculation of the static stress-strain state of the middle ear was made in this paper. The malleus, incus and stapes models were constructed on the basis of tomographic data. The tympanic membrane model was obtained using the equations of elliptic hyperboloids. The tympanic membrane consists of the pars tensa and pars flaccida, which have different thicknesses and elasticity moduli. Absolute deformations of the tympanic membrane were defined at different values of negative pressure in the tympanic cavity. The critical values of elastic modulus for the pars tensa posterosuperior quadrant were found for the point at which the tympanic membrane touches the auditory ossicles. Obtained results can be used to predict the thickness of a cartilaginous graft which is overlaid on the posterosuperior quadrant of the pars tensa in order to eliminate the retraction pocket.