title: Relationship between tympanic membrane retraction and habitual sniffing in patients with cholesteatoma.
abstract: CONCLUSIONS
  Habitual sniffing affects the pathogenicity and recurrence of cholesteatoma. Postoperative instructions requesting patients to cease sniffing may reduce the retraction and recurrence of cholesteatoma.
  
  
  OBJECTIVE
  To examine the relationship between tympanic membrane retraction and habitual sniffing in patients with cholesteatoma.
  
  
  METHODS
  We recruited 98 patients (102 ears) who were surgically treated for cholesteatoma by canal wall-down tympanoplasty (22 ears) or canal wall-down tympanoplasty with reconstruction methods (80 ears). We classified these patients into two groups on the basis of their preoperative habitual sniffing: habitual and non-habitual sniffers. The findings of the contralateral tympanic membrane were examined in each group and were classified according to the Tos classifications. Next, we evaluated the incidence of 1-year postoperative tympanic membrane retraction treated by the canal-down tympanoplasty with reconstruction method in the following three groups: non-habitual sniffing group, sniffing cessation group, and continual sniffing group.
  
  
  RESULTS
  In habitual sniffers, the Tos classifications of contralateral tympanic membrane were normal in 7% (3/41). In contrast, for non-habitual sniffers, the findings were normal in 39% (21/54). These results indicate that sniffing causes tympanic membrane retraction. The tympanic membranes of patients in the sniffing cessation group were largely normal after surgery. However, more than 50% of the patients who continued to sniff after surgery showed retraction or recurrent cholesteatoma.
authors.affiliation: Department of Otorhinolaryngology/Head & Neck Surgery, Hamamatsu University School of Medicine , Hamamatsu, Shizuoka.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takizawa
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Mizuta
authors.forename: Noboru
authors.initials: N
authors.lastname: Hamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamatodani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hosokawa
authors.forename: Goro
authors.initials: G
authors.lastname: Takahashi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mineta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018424:Cholesteatoma, Middle Ear / Q000503:physiopathology / Q000601:surgery*; D005064:Eustachian Tube / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation / Q000379:methods*; D009666:Nose / Q000503:physiopathology*; D038781:Otoscopy; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*; D055815:Young Adult