Surgery for tympanic membrane retraction pockets

The tympanic membrane, or eardrum, is a thin piece of tissue that separates the external ear from the middle ear. Its main function is to transmit sound from the air to the three small bones of the middle ear. A retraction of the tympanic membrane happens when all or a segment of the membrane collapses inwards towards the middle ear. Tympanic membrane retractions are commonly managed by ENT surgeons but there is currently no consensus as to the indications, timing and options for management of this condition. We identified only two randomised controlled trials, involving 71 participants, which could be included in this review. One was a small study which showed no statistically significant benefit of cartilage graft tympanoplasty over a watch and wait policy, either for disease progression or hearing. The other showed no additional benefit from the insertion of ventilation tubes ('grommets') over cartilage tympanoplasty alone for patients' hearing. Further high quality studies are much needed.

Authors' conclusions: 

No evidence currently exists to either support or refute the role of surgery in the management of tympanic membrane retractions. Higher quality studies are much needed to ascertain this.

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Background: 

Tympanic membrane retractions are commonly managed by ENT surgeons. There is currently no consensus as to the indications, timing and options for management of this condition.

Objectives: 

To study the effectiveness of different surgical options in the management of tympanic membrane retractions.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 1); PubMed (1950 to 2010); EMBASE (1974 to 2010); CINAHL (1982 to 2010); BIOSIS Previews; ISI Web of Science; CAB Abstracts; LILACS; KoreaMed; IndMed; PakMediNet; China National Knowledge Infrastructure; ISCTRN; UKCRN; ICTRP and Google. The date of the search was 17 March 2010.

Selection criteria: 

Randomised controlled trials (RCTs) of the surgical management of tympanic membrane retraction pockets in adults or children. Staging of the retraction using a known system must have been performed. Studies of cholesteatoma or perforations were excluded.

Data collection and analysis: 

Two authors independently collected and analysed data to minimise the effects of selection and reporting bias.

Main results: 

Two RCTs were included, involving 71 participants. The first study showed no statistically significant benefit of cartilage graft tympanoplasty over a watch and wait policy for either disease progression or hearing outcome. The second showed no additional benefit from the insertion of ventilation tubes over cartilage tympanoplasty alone with regards to hearing outcome.

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