A narrative review of the management of pars flaccida tympanic membrane retractions without cholesteatoma.

OBJECTIVE

Review the effectiveness of surgical and non-surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma.

DESIGN

Narrative review.

SETTING

ENT and otology services worldwide.

PARTICIPANTS

Patients with non-cholesteatoma tympanic membrane retractions.

MAIN OUCTOME MEASURE

Changes in retraction (progression or resolution, or development of a known sequela such as perforation).

RESULTS

Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures.

CONCLUSION

Few high-quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence.