Parkes William, Vilchez-Madrigal Luis, Cushing Sharon, Papsin Blake, James Adrian
Clinic of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Clinic of Otolaryngology, National Children's Hospital, San Jose, Costa Rica.
J Int Adv Otol. 2018 Aug;14(2):250-254. doi: 10.5152/iao.2018.5609.
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.
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.
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.
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.
鼓膜内陷的自然病程不可预测。为了获取用于指导监测和治疗的预后信息，对一组腭裂导致鼓膜内陷的儿童进行了超过5年的前瞻性随访。
这是一项在三级学术机构进行的前瞻性观察研究。从143名腭裂儿童队列中选取紧张部内陷的儿童。在平均年龄9岁时，对37只耳朵进行耳内镜图像采集和听力测定评估，并在平均随访间隔6.4年后重新评估。由四位对图像日期不知情的儿科耳鼻喉科医生比较每只耳朵系列图像中鼓膜内陷的严重程度。
最初有19/37例（51%）内陷表现为与砧骨和/或岬接触。随访图像显示，28/37例（76%）内陷被评为稳定（n = 16）或改善（n = 12）。在9例内陷加重的病例中，2例发展为胆脂瘤（占总数的5%）。无胆脂瘤的耳朵未发生听骨侵蚀。最初有5只耳朵存在传导性听力损失（4个音调平均气骨导间距>25分贝听力级），其中1只加重，其他未干预的耳朵听力恢复正常。最初听力正常的耳朵均未出现听力损失。
在这组存在持续性咽鼓管功能障碍风险的儿童中，大多数鼓膜内陷随时间推移保持稳定或改善。临床上显著的进展很少发生，证明了对这些内陷采取保守治疗方法的合理性。此类数据对于权衡预防性干预相对于观察的潜在益处是必要的。
