Erosion of the incus in pediatric posterior tympanic membrane retraction pockets without cholesteatoma.

摘要

OBJECTIVE: To determine the incidence of erosion of the incus in pediatric patients operated for atelectasis with postero-superior retraction pockets and incudopexy. Associated hearing loss was determined and a comparison was made between the patients with and without incus erosion. METHODS: Observational study of patients seen and operated at the Sophia Children's Hospital in Rotterdam between 2002 and 2005. All patients who had undergone surgery for posterior retraction pockets with preoperative evidence of fixation of the tympanic membrane to the incudo-stapedial complex were identified for the study. Patients with evidence of cholesteatoma (epithelial debris within the pockets) were excluded from the study. Pre- and postoperative air and bone conduction thresholds and air-bone gaps were calculated using the four-tone pure-tone average for bone- and air conduction. RESULTS: In this study of 46 ears with posterior retractions adherent to the incus, 30% were found to have some degree of erosion of theincus associated with incudopexy. In the group with incudopexy without erosion the preoperative and postoperative air-bone gaps were 10.0+/-9.8 and 5.9+/-8.3dB respectively. The pre-and postoperative air-bone gaps in the incus erosion group were 20.1+/-13.3 and 13.8+/-9.1dB respectively. The audiological differences between the erosion group and the non-erosion group and between pre- and postoperative air-bone gaps were statistically significant. CONCLUSION: In this group of children with posterior retraction pockets adherent to the incus, we found at surgery a high incidence of erosion of the incus. The audiometric data confirms that early surgery does not adversely affect the postoperative hearing where there is no erosion of the incus, and likewise the improvement in air-bone gap postoperatively was statistically significant in the erosion group. On the basis of these findings we suggest that watchful waiting may not be the best strategy in pediatric atelectasis once the tympanic membrane has become adherent to the ossicular chain.