Pars tensa and pars flaccida retractions in persistent otitis media with effusion

Abstract

Objective: In children with otitis media with effusion (OME), to investigate the incidence of, and any association, between retractions of the pars tensa and pars flaccida; to assess the effect of pars tensa and pars flaccida retractions on the hearing; to investigate risk factors for retractions; and to document the natural history of such retractions over a 12-week 'watchful aiting" period.

Study design: Prospective, observational study.

Setting: Sixteen departments of otolaryngology in hospitals in the U.K.

Patients: A cohort of 1,267 children aged 3.25 to 6.75 years with confirmed OME. None had previously received surgical intervention.

Interventions: Follow-up over a "watchful waiting" period of 12 weeks.

Main outcome measures: Otoscopy and pure-tone audiometry.

Results: Retraction of the pars tensa to the incus or promontory occurred in 8% of the better-hearing ears and 10% of the poorer-hearing ears. Pars flaccida retraction to the malleus or farther occurred in 4.5% of the better-hearing ears and 5.5% of the poorer-hearing ears. Retractions were not associated with a longer history of hearing problems. Pars tensa or pars flaccida retraction in association with OME did not materially affect the hearing. Pars tensa retractions, followed up over a 12-week period, resolved in 69% of the better-hearing ears and 65% of the poorer-hearing ears. In 14% and 10% of ears, respectively, the OME had also resolved.

Conclusions: There is minimal evidence to support the concept that pars tensa or pars flaccida retractions are a strong or relevant marker for the severity or evolution of OME in children. Prospective studies over a longer period of follow-up are required to confirm this.