Evaluation of attic retraction pockets by microendoscopy.
OBJECTIVE
Attic retraction pockets (RPs) are one of the important sequelae of otitis media with effusion and are classified on the basis of the findings of otoscopy or otomicroscopy. It is unclear when and how RPs turn into cholesteatomas. We compared the findings of RPs obtained with the use of a microendoscope with those from an otomicroscope to determine the extension of RPs.


METHODS
Comparative study.


METHODS
Twenty-seven attic RPs (Tos type III or IV) and 10 precholesteatomas previously classified under an otomicroscope were reexamined.


METHODS
A high-resolution, fine, rigid microendoscope with an outer diameter of 1.0 mm was used to observe the extension of a retraction. In addition, to confirm the extent of the RP, computed tomography (CT) scans using water as the contrast media were performed in representative cases.


RESULTS
Endoscopy with the microendoscope revealed that in 59%, the RP was deeper than indicated by the initial otomicroscopic estimation, suggesting that the extension of the RP was underestimated. The findings of water-enhanced CT scans were comparable with the endoscopic findings. The bottom was observable with the microendoscope and the otomicroscope in 20 (74%) and 11 (41%) of 27 RPs, respectively. Seven ears had a deeper RP, which extended beyond the incudomallear joint. Of the 10 precholesteatoma cases, in which the bottoms were not visible with an otomicroscope or conventional endoscopes, the microendoscope revealed the bottom in 5 (50%).


CONCLUSIONS
On the basis of the observations of our study, we suggest that reexamination of cases of RP classified as Tos type III or IV, preferably with a microendoscope, if available, and assessment of the depth of the RP using water-enhanced CT, would be useful and that careful follow-up is necessary for deep RPs because of a potential risk of development into cholesteatoma.
Kakehata
Seiji
S
Department of Otorhinolaryngology, Hirosaki University School of Medicine, Hirosaki, Japan. seijik@cc.hirosaki-u.ac.jp
Hozawa
Koji
K
Futai
Kazunori
K
Shinkawa
Hideichi
H
D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000145:classification / Q000209:etiology / Q000473:pathology*; D004427:Ear Diseases / Q000145:classification / Q000209:etiology / Q000473:pathology*; D004432:Ear, Middle / Q000000981:diagnostic imaging / Q000473:pathology*; D019723:Endoscopes / Q000639:trends*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000150:complications* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014741:Video Recording / Q000295:instrumentation