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Original article • Braz. j. otorhinolaryngol. 89 (1) • Jan-Feb 2023 • https://doi.org/10.1016/j.bjorl.2021.10.005   copy

Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane★ ★ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. , ★★ ★★ Study conducted at the Department of Otolaryngology – Head and Neck Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Centro de Otite Média do Brasil – com.br.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps.

Methods:

A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program.

Results:

661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation.

Conclusion:

The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG threshold, only for PT.

Evidence level: 4.

Keywords
Tympanic membrane retraction; Pars flaccida; Pars tensa; Air bone gap

Highlights

The literature is scarce in demonstrating the correlation between the degree of severity of retractions and the degree of hearing loss.

To analyse the differences in the location, the severity, and the air-bone gap of moderate and severe tympanic membrane retractions.

After a global analysis of the behavior these retractions, we observed the need for classifications that evaluate them globally.

Identification of these gaps in literature is relevant so that the focus may be shifted on these topics and proper studies may be implemented.

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br
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