The extraordinary healing properties of the pediatric tympanic membrane: A study of atelectasis in the pediatric ear

Objectives: Traumatic perforations of the eardrum are generally treated conservatively as they tend to heal spontaneously. Retraction pockets of the eardrum, leading to atetectasis of the middle ear and often ultimately though unpredictably, to cholesteatoma formation, are treated in a variety of ways including complex grafting procedures. On the premise that a surgically resected retraction pocket is in essence a traumatic perforation, we examined the results of spontaneous heating of the resected retraction pocket. Methods: Retrospective case note study. Patients: A group of 86 ears in 62 patients who had undergone simple excision of the atrophic segment of the eardrum and who had no grafting procedure of the resultant defect, were followed at 6 days, 6-7 weeks and then every 6 months to determine the incidence of spontaneous heating of the eardrum. Audiograms were taken preoperatively, at 7 weeks and between 7 and 15 months postoperative. Results: 94.2% of the eardrums (81 out of 86 ears) heated spontaneously without any form of grafting within 7 weeks. Air bone gap showed improvement in 53 patients. Only one of the four ears that failed to achieve closure had postoperative ear discharge. There were no other complications. In 17 ears (19.8%) there was a recurrence of the atelectasis. Conclusion: Excision of retraction pockets in pediatric ear atetectasis, in principle does not require grafting, as the great majority will heal spontaneously. The spontaneous heating in this study is comparable to reported studies of spontaneous heating of traumatic perforations. Irrespective of the size of the atrophic part of the membrane, recurrence rates for the atelectasis after simple excision is similar to that described in other studies. Retraction pockets may be excised and allowed to heat without risk to the hearing. (C) 2008 Published by Elsevier Ireland Ltd