Cartilage tympanoplasty for posterosuperior retraction pockets of the pars tensa in children.
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.
Couloigner
Vincent
V
Department of Pediatric Oto-Rhino-Laryngology, Hôpital Robert Debré, AP-HP, Paris, France.
Molony
N
N
Viala
P
P
Contencin
P
P
Narcy
P
P
Van Den Abbeele
T
T
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*