title: Cartilage tympanoplasty for posterosuperior retraction pockets of the pars tensa in children.
abstract: OBJECTIVE
  To assess the functional and anatomic results of cartilage grafting in children with a severe retraction pocket of the posterosuperior part of the pars tensa and operated on by pocket excision and cartilage grafting.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Fifty six children (60 ears) with severe posterosuperior retraction pockets.
  
  
  METHODS
  Excision of the pocket and tympanic reinforcement with a tragal or conchal cartilaginous graft.
  
  
  METHODS
  Postoperative anatomic (otoscopy, computed tomography) and functional (pure tone audiometry thresholds) outcome. The follow-up time was 27 +/- 18 months (mean +/- SD).
  
  
  RESULTS
  Retraction recurrences requiring additional surgery occurred in 5 cases (8%). The risk of recurrence was lower in children older than 10 years and when the whole surface of the pars tensa was reinforced (chi(2) test, p< 0.05 for both factors). Functionally, hearing was improved even when the ossicular chain was intact. In case of disrupted ossicular chain, direct contact between the graft and eroded incudostapedial joint gave good hearing results.
  
  
  CONCLUSIONS
  Cartilage reinforcement of the whole surface of the pars tensa is probably the best treatment of a severe posterosuperior retraction pocket. The flexibility and thinness of cartilage from the cymba conchae makes it particularly suitable in this indication.
authors.affiliation: Department of Pediatric Oto-Rhino-Laryngology, Hôpital Robert Debré, AP-HP, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Couloigner
authors.forename: N
authors.initials: N
authors.lastname: Molony
authors.forename: P
authors.initials: P
authors.lastname: Viala
authors.forename: P
authors.initials: P
authors.lastname: Contencin
authors.forename: P
authors.initials: P
authors.lastname: Narcy
authors.forename: T
authors.initials: T
authors.lastname: Van Den Abbeele
mesh_terms: D002356:Cartilage / Q000637:transplantation*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D014420:Turbinates / Q000637:transplantation; D014432:Tympanic Membrane / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*