Management of tympanic membrane retractions: a systematic review

Abstract

Importance Tympanic membrane retraction (TMR) is a relatively common otological finding. However, no consensus on its management exists. We are looking especially for a treatment strategy in the military population who are unable to attend frequent follow-up visits, and who experience relatively more barotrauma at great heights and depths and easily suffer from otitis externa from less hygienic circumstances. Objective To assess and summarize the available evidence for the effectiveness of surgical interventions and watchful waiting policy in patients with a tympanic membrane retraction. Evidence review The protocol for this systematic review was published at Prospero (207859). PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched from inception up to September 2020 for published and unpublished studies. We included randomized trials and observational studies that investigated surgical interventions (tympanoplasty, ventilation tube insertion) and wait-and-see policy. The primary outcomes of this study were clinical remission of the tympanic membrane retraction, tympanic membrane perforations and cholesteatoma development. Findings In total, 27 studies were included, consisting of 1566 patients with TMRs. We included data from 2 randomized controlled trials (76 patients) and 25 observational studies (1490 patients). Seven studies (329 patients) investigated excision of the TMR with and without ventilation tube placement, 3 studies (207 patients) investigated the wait-and-see policy and 17 studies (1030 patients) investigated tympanoplasty for the treatment of TMRs. Conclusions and relevance This study provides all the studies that have been published on the surgical management and wait-and-policy for tympanic membrane retractions. No high level of evidence comparative studies has been performed. The evidence for the management of tympanic membrane retractions is heterogenous and depends on many factors such as the patient population, location and severity of the TMR and presence of other ear pathologies (e.g., perforation, risk of cholesteatoma and serous otitis media).

Possible clinical implications of the structural variations between the tympanic membrane quadrants

“…The biological difference between the pars tensa and pars flaccida can be found in the lamina propria. The lamina propria of the pars flaccida consists primarily of loose and unorganized connective tissue and is thicker than the pars tensa 19 . The unorganized fibers in its connective tissue make the structural arrangements within the pars flaccida weaker and more likely to retract 20…”

“…Furthermore, this analysis shows that the maximum radii between the umbo and the tensa. 19 The unorganized fibers in its connective tissue make the structural arrangements within the pars flaccida weaker and more likely to retract. 20 In agreement with our analysis, Paço et al 10 found that the SPQ has the largest area, representing 28.7% of the area of the eardrum.…”

Differential Tympanic membrane retraction

“…1 Chronic otitis media is an inflammatory condition that affects the middle ear and can cause atelectasis, perforation, tympanosclerosis, retraction pocket formation, and cholesteatoma. 2 The tympanic membrane becomes floppy and forms a retraction pocket when there is a fluctuating or prolonged negative middle ear pressure. Adhesive otitis media develops as a result of retraction and related middle ear inflammation.…”