title: Temporalis fascia graft perforation and retraction after tympanoplasty for chronic tubotympanic otitis and attic retraction pockets: factors associated with recurrence.
abstract: OBJECTIVE
  To correlate the recurrence of temporalis fascia graft perforation and retraction in adults and children after tympanoplasty for chronic tubotympanic otitis and deep attic retraction pockets with age, pathologic process, mucosal lesions, mucociliary transport time, chronic sinusitis, and lateral attic wall reconstruction.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Two hundred seventy-four adult ears and 41 child ears were operated on for chronic tubotympanic otitis, 50 adult ears were operated on for traumatic tympanic membrane rupture, and 56 adult ears were operated on for attic retraction pockets.
  
  
  METHODS
  Underlay tympanoplasty with or without mastoidectomy and lateral attic wall reconstruction for attic retraction pockets. Mucociliary transport time was investigated using saccharin testing.
  
  
  METHODS
  Recurrent perforation, recurrent attic retraction, and temporalis fascia graft retraction were evaluated.
  
  
  RESULTS
  Higher incidences of recurrent perforation were found in adults operated on for tubotympanic otitis vs traumatic tympanic membrane rupture (P = .02) and in children (P = .004), especially those 9 years and younger (P = .02). A risk factor in adults was chronic sinusitis (risk ratio, 35.0; 95% confidence interval, 32.1-38.2; P = .004). Temporalis fascia graft retraction correlated with slower mucociliary transport time in adults (P < .001). A lower incidence of recurrent attic retraction was associated with lateral attic wall reconstruction (P < .001).
  
  
  CONCLUSIONS
  Recurrent temporalis fascia graft perforation after tympanoplasty for tubotympanic otitis may be related to age and coexisting chronic sinusitis. Temporalis fascia graft retraction correlates with slower mucociliary transport time in the eustachian tube. Lateral attic wall reconstruction minimizes recurrent attic retraction in adults.
authors.affiliation: Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia. xeniam@sezampro.rs
authors.forename: Snezana D
authors.initials: SD
authors.lastname: Jesic
authors.forename: Milovan V
authors.initials: MV
authors.lastname: Dimitrijevic
authors.forename: Vladimir S
authors.initials: VS
authors.lastname: Nesic
authors.forename: Ana D
authors.initials: AD
authors.lastname: Jotic
authors.forename: Nikola A
authors.initials: NA
authors.lastname: Slijepcevic
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D002908:Chronic Disease; D004487:Edema / Q000209:etiology; D005064:Eustachian Tube; D005205:Fascia / Q000637:transplantation*; D006801:Humans; D009079:Mucociliary Clearance; D010033:Otitis Media / Q000601:surgery*; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications; D013524:Surgical Flaps; D013703:Temporal Muscle; D014432:Tympanic Membrane / Q000601:surgery*; D018058:Tympanic Membrane Perforation / Q000209:etiology*; D014433:Tympanoplasty / Q000009:adverse effects*