title: Pars tensa retractions without cholesteatoma in children: predictors for ossicular chain destruction, air conduction thresholds, and postoperative retractions.
abstract: OBJECTIVE
  Determine predictive values of preoperative stages of pars tensa retractions, coexisting attic retraction and preoperative air conduction for ossicular destruction in isolated and combined pars tensa retraction, and predictors for successful tympanic grafts after surgery.
  
  
  METHODS
  Prospective case series study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Forty-eight children ears without cholesteatoma were included in the study: 23 with isolated pars tensa retraction (median age, 11), 25 with combined pars tensa and attic retractions (median age, 13).
  
  
  METHODS
  Otomicroscopy, pure tone audiometry, and impedancmetry were carried out preoperatively. Three surgical procedures for isolated retractions were used: ventilation tube insertion alone or together with fascia graft or cartilage graft. Two surgical procedures for combined retractions were used: ventilation tube insertion alone and with cartilage graft.
  
  
  METHODS
  Incidence of ossicular destruction, postoperative retraction of the grafts.
  
  
  RESULTS
  Stage of pars tensa retraction and preoperative air conduction thresholds do not predict long incus process defect in isolated group. Coexistence of an attic retraction predicts combined, long incus process and stapes superstructure defect (Chi = 3.943, p = 0.047, OR = 12.00). Retractions of grafts are predicted by mode of surgery, favoring cartilage graft (isolated group: Chi = 4.306, p = 0.0372,OR = 4.69; combined group Chi = 4.7836, p = 0.0287, OR = 0.1364). Stage of pars tensa retraction predicts poor outcome of fascia graft (Chi = 4.5347, p = 0.0332, OR = 12.00).
  
  
  CONCLUSIONS
  Absence of correlation between stage of pars tensa retraction and air conduction thresholds with ossicular defects justifies surgical exploration of the auditory ossicles, even in lower stages of retraction. Combined ossicular defect is expected in combined retractions. The usage of cartilage graft proved to be more appropriate.
authors.affiliation: *School of Medicine, University of Belgrade, Serbia, Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia; †Clinic for Children Diseases, Department of Otorhinolaryngology, Clinical Centre of Montenegro, Podgorica, Montenegro; and ‡Centre for Endocrine Surgery, Clinic for Endocrinology, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Snezana Dragoljub
authors.initials: SD
authors.lastname: Jesic
authors.forename: Lejla Hilmo
authors.initials: LH
authors.lastname: Rovcanin
authors.forename: Ognjen Djordjije
authors.initials: OD
authors.lastname: Jovicevic
authors.forename: Ana Dragan
authors.initials: AD
authors.lastname: Jotic
authors.forename: Nikola Aleksandar
authors.initials: NA
authors.lastname: Slijepcevic
authors.forename: Vladimir Radoslav
authors.initials: VR
authors.lastname: Ljubic
mesh_terms: D000293:Adolescent; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000601:surgery; D004429:Ear Ossicles / Q000473:pathology / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology / Q000601:surgery*; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods*