Natural History of Tympanic Membrane Retraction in Children with Cleft Palate
| Autor: | William J. Parkes, Adrian L. James, Sharon L. Cushing, Blake C. Papsin, Luis D. Vilchez-Madrigal |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Tympanic Membrane Adolescent Hearing loss Incus Hearing Loss Conductive macromolecular substances Severity of Illness Index Tympanic membrane retraction Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine medicine otorhinolaryngologic diseases Humans Prospective Studies 030223 otorhinolaryngology Prospective cohort study Child Ear Ossicles medicine.diagnostic_test Cholesteatoma Middle Ear business.industry Eustachian Tube digestive oral and skin physiology Cholesteatoma Reproducibility of Results General Medicine medicine.disease Conductive hearing loss Surgery Cleft Palate Otorhinolaryngology Hearing level Acoustic Impedance Tests Disease Progression Audiometry Pure-Tone Original Article medicine.symptom Audiometry business 030217 neurology & neurosurgery |
| Popis: | Objectives The natural history of tympanic membrane retraction is unpredictable. To obtain prognostic information for guiding surveillance and treatment, a cohort of children with retraction from cleft palate were prospectively followed for over 5 years. Materials and methods This was a prospective observational study at a tertiary academic institution. Children with pars tensa retraction were selected from a cohort of 143 children with cleft palate. Thirty-seven ears were assessed with otoendoscopic image capture and audiometry at a median age of 9 years and reassessed at a median follow-up interval of 6.4 years. The severity of tympanic membrane retraction in the serial images of each ear was compared by four pediatric otolaryngologists blinded to the dates of the images. Results Initially, 19/37 retractions (51%) demonstrated contact with the incus and/or promontory. Follow-up images were rated as stable (n=16) or better (n=12) for 28/37 retractions (76%). Of the nine retractions that became more extensive, two developed cholesteatoma (5% of the total). No ossicular erosion developed in ears without cholesteatoma. Conductive hearing loss (4-tone average air-bone gap >25 decibels hearing level) was initially present in five ears, worsened in one, and normalized without intervention in others. No ears with initial normal hearing developed hearing loss. Conclusion Most tympanic membrane retractions remained stable or improved over time in this cohort of children who were at a risk of persistent eustachian tube dysfunction. Clinically significant progression occurred infrequently, justifying the conservative approach taken to manage these retractions. Such data are necessary to weigh the potential benefit of preventive intervention over observation. |
| Databáze: | OpenAIRE |
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