Management of retraction pockets of the pars tensa.

A study of 73 patients with retraction pockets of the pars tensa (93 affected ears) has been carried out. Of these 32 per cent had otalgia and 31 per cent reported episodes of aural discharge. Adequate audiometric data was available on 75 ears. Mean air-bone gaps were calculated using 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Thirty per cent of ears had air-bone gaps of less than 10 dB and in 93 per cent the air-bone gap was less than 30 dB. Air-bone gaps of more than 40 dB were found in seven per cent. Of this group, seven patients were selected for surgical treatment. In all cases the retraction pockets were elevated and averted. In six cases, the thinned tympanic membrane was reinforced with a composite graft of cartilage and perichondrium. This technique has also been used in three patients not included in this study group. An ossiculoplasty was performed in four cases. In the early months, the retraction pockets remained completely everted. However, by 12 months some degree of retraction had recurred in four of the six patients who have been followed for more than 12 months.