BACKGROUND: Retraction pocket (RP) of the tympanic membrane (TM) is a common pathology in children that can cause ossicular chain erosion, cholesteatoma formation, and potentially life-threatening complications of cholesteatoma. This study assessed the functional and anatomical results of cartilage grafting in children with severe RP of the TM. METHODS: This was a retrospective review of 212 children from a tertiary referral center. RESULTS: We identified significant differences in hearing results, indication criteria, and location of TM fixation between stages II and III of RP (according to Charachon). We observed a significantly higher incidence of RP in boys than in girls. CONCLUSIONS: Cartilage tympanoplasty for retraction pocket of the tympanic membrane in children is a safe procedure with good anatomical and hearing results.

Department of Pediatric Otorhinolaryngology University Hospital Brno and Faculty of Medicine of Masaryk University Brno Czech Republic

Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic

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de Beer BA, Schilder AGM, Zielhuis GA, Graamans K. Natural course of tympanic membrane pathology related to otitis media and ventilation tubes between ages 8 and 18 years. Otol Neurotol. (2005) 26(5):1016–21. 10.1097/01.mao.0000185058.89586.ed PubMed DOI

Bunne M, Falk B, Magnuson B, Hellström S. Variability of eustachian tube function: comparison of ears with retraction disease and normal middle ears. Laryngoscope. (2000) 110(8):1389–95. 10.1097/00005537-200008000-00032 PubMed DOI

Sadé J. Treatment of cholesteatoma and retraction pockets. Eur Arch Otorhinolaryngol. (1993) 250:4. 10.1007/bf00171523 PubMed DOI

Urík M, Hurník P, Žiak D, Macháč J, Šlapák I, Motyka O, et al. Histological analysis of retraction pocket pars tensa of tympanic membrane in children. Int J Pediatr Otorhinolaryngol. (2016) 86:213–7. 10.1016/j.ijporl.2016.05.007 PubMed DOI

Urík M, Hurník P, Žiak D, Macháč J, Šlapák I, Motyka O, et al. Immunohistochemical analysis of retraction pocket pars tensa of tympanic membrane in children. Int J Pediatr Otorhinolaryngol. (2019) 122:111–6. 10.1016/j.ijporl.2019.04.008 PubMed DOI

Urík M, Tedla M, Hurník P. Pathogenesis of retraction pocket of the tympanic membrane—a narrative review. Medicina (Kaunas). (2021) 57(5):425. 10.3390/medicina57050425 PubMed DOI PMC

Shunyu NB, Gupta SD, Thakar A, Sharma SC. Histological and immunohistochemical study of pars tensa retraction pocket. Otolaryngol Head Neck Surg. (2011) 145(4):628–34. 10.1177/0194599811409303 PubMed DOI

Sadé J. Retraction pockets and attic cholesteatomas. Acta Otorhinolaryngol Belg. (1980) 34(1):62–84. PubMed

Tos M, Poulsen G. Attic retractions following secretory Otitis. Acta Otolaryngol. (1980) 89(3–6):479–86. 10.3109/00016488009127165 PubMed DOI

Charachon R, Barthez M, Lejeune JM. Spontaneous retraction pockets in chronic otitis media medical and surgical therapy. Ear Nose Throat J. (1992) 71:578–83. 10.1177/014556139207101109 PubMed DOI

Jesić S, Rovcanin LH, Jovicevic OD, Jotić A, Slijepčević N, Ljubic VR. Pars tensa retractions without cholesteatoma in children. Otol Neurotol. (2014) 35(6):997–1002. 10.1097/mao.0000000000000316 PubMed DOI

Alper CM, Olszewska E. Assessment and management of retraction pockets. Otolaryngologia Polska. (2017) 71(1):1–21. 10.5604/01.3001.0009.5547 PubMed DOI

Wetmore WF, Muntz HR, McGill TJ, editors. Pediatric Otolaryngology: Principles and Practice Pathways. 2nd ed. Stuttgart: Thieme Medical Publishers; (2012). p. 253–64.

Couloigner V, Molony N, Viala P, Contencin P, Narcy P, Den V. Cartilage tympanoplasty for posterosuperior retraction pockets of the pars tensa in children. Otol Neurotol. (2003) 24(2):264–9. 10.1097/00129492-200303000-00022 PubMed DOI

Ramakrishnan Y, Kotecha A, Bowdler DA. A review of retraction pockets: past, present and future management. J Laryngol Otol. (2007). 121(6):521–5. 10.1017/s0022215106003550 PubMed DOI

Glasscock ME, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: a follow-up report. Laryngoscope. (1982) 92:718–27. 10.1288/00005537-198207000-00002 PubMed DOI

Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope. (1987) 97(9):1069–74. 10.1288/00005537-198709000-00013 PubMed DOI