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

Abstract

AbstractObjectiveReview 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.DesignNarrative review.SettingENT and otology services worldwide.ParticipantsPatients with non‐cholesteatoma tympanic membrane retractions.Main Ouctome measureChanges in retraction (progression or resolution, or development of a known sequela such as perforation).ResultsEight 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.ConclusionFew 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.