An interventional study of pars tensa retraction pockets - a comparison between grommet insertion and medical management .

Chithra, Revi (2013) An interventional study of pars tensa retraction pockets - a comparison between grommet insertion and medical management . Masters thesis, Coimbatore Medical College, Coimbatore.


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BACKGROUND OF THE STUDY Surgical management of retraction pockets of tympanic membrane is still controversial. In patients with no predisposing cause , the course cannot be predicted. In some patients it progresses towards cholesteatoma & in some it remains asymptomatic. Hence dilemma arises in surgically managing the retraction pockets as the hearing acuity remains normal until later in the disease course & we are not able to predict the course towards cholesteatoma. AIMS AND OBJECTIVES 1. To find out whether early intervention of retraction pockets can prevent progression to cholesteatoma. 2. To compare the efficacy of myringotomy and grommet insertion and medical measures in the management of pars tensa retraction pockets. MATERIALS AND METHODS This study titled “An interventional study of Pars tensa retraction pockets - A comparison between grommet insertion and medical management” was done in the Department of Otorhinolaryngology, Coimbatore Medical College Hospital from September 2011 to Novenber 2012. Patients attending the outpatient department who had Pars tensa retraction pockets of grades II and III according to Sade’s classification and having no predisposing nasopharyngeal and paranasal sinus pathologies were selected and divided randomly into two groups. Each group comprised 25 patients each. Pre operative evaluation was done using Video-otoscopy , Pure tone audiometry , Impedence audiometry , Diagnostic nasal endoscopy and in selected patients CT scan of Paranasal sinuses. Patients in one group were managed conservatively by using antihistamines , nasal decongestants, topical steroids , and were asked to perform regular Valsalva manouvre . Patients in second group were treated by myringotomy and grommet insertion. Both the groups were followed up for 6 months by regular videootoscopy and pure tone audiometry for reversal or progression of retraction and improvement or worsening of hearing. The results were compared at first month , third month and sixth month postoperatively for significant difference between the two lines of management. OBSERVATIONS AND RESULTS From our study it was found out that there was definite improvement in the grade of tympanic membrane retraction and hearing thresholds by early intervention. During follow up examination for a period of 6 months ,there was definite improvement in the grade of tympanic membrane retractions by reversal of retraction pockets (86.9%) in group managed by grommet insertion with a definite improvement in hearing levels as suggested by reduction in air – bone gap in pure tone audiograms (87%). In the group of patients treated medically , there was reversal of retraction in 63.9 % of patients with improvement in hearing for 40.9% of patients. The results were analysed and compared using Chi-square testing and found to be statistically significant suggesting that there is a definite advantage of myringotomy and grommet insertion over medical measures in the early management of retraction pockets of tympanic membrane. CONCLUSION From our study it was inferred that progression of retraction pockets was significantly reduced by early intervention whether it is in the form of medical measures or surgery. By comparing the efficacy of the two lines of management it was found out that surgically managed group showed better outcomes both with respect to the status of retraction as well as degree of hearing improvement. The incidence of complications following surgery was not much significant as compared to the favourable outcomes. Early intervention was shown to definitely arrest the progression of retraction pocket to cholesteatoma and thus a ‘safe’ ear to ‘unsafe’ ear. Thus we conclude that management of pars tensa retractions by myringotomy and grommet insertion is a safe, effective and simple procedure and should be always considered ahead of conservative medical management and extensive tympanoplasty in appropriate cases.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pars tensa retraction pockets; myringotomy; grommet insertion; medical management
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 10 Jul 2017 11:10
Last Modified: 10 Jul 2017 11:10

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