Attic retractions following secretory otitis.

At re-examination of 527 ears with secretory otitis 3 to 8 years after tubulation otomicroscopy and tympanometry revealed different types of retraction of Shrapnell's membrane in 34%, of these 4.2% had pronounced retraction with resorption of the osseous annulus and 0.2% had atticus cholesteatoma. There was a close correlation between the frequency and severity of retraction on the one hand and the age of the patient at reexamination, the tympanometric conditions, and the pathology of pars tensa on the other. The continued progression is further promoted by a lack of natural cleansing of the retraction. As the frequency of secretory otitis is very high in children the 4.2% of pronounced retractions constitute a sufficient quantitative basis for a direct progression to atticus cholesteatoma.