Objective: The aim of our study was to specify the characteristics of retraction pockets (RP) in children and to evaluate the outcomes of their surgical treatment.
Methods: A retrospective study about 37 retraction pockets (stage II and III Charachon) in 27 children during a period of twelve years (between 2007 and 2018). All patients had otomicroscopic examination, nasal endoscopy, audiometric exam and radiological investigations (tomodensitometry or cone beam).
Results: The average age of our patients was 10.9. A male predominance was found with a sex ratio of 1.64. 38% of retraction pockets were stage II Charachon and 62% were stage III. 78 % had cartilage tympanoplasty type I and 22% had cartilage tympanoplasty type II. The surgery was bilateral in fourteen patients. We performed a reinforcement tympanoplasty with a retro auricular approach in all cases using: a cartilage- perichondrium composite graft in 28 cases, a cartilage- temporalis fascia composite graft in four cases and only cartilage in five cases. Intraoperatively, the erosion of the ossicular chain was noted in 10 cases. Ossiculoplasty was performed using autologous ossicules in eight cases and total ossicular replacement prosthesis (TORP) in one case. Adenoidectomy was performed in 4 cases. Four patients had septoplasty after few months of the tympanoplasty.
The post-operative mean follow up was 32 months. We had good anatomic results in 87% of cases. We noted a graft perforation in one case and graft retraction in one case. The average hearing improvement in our patients was 12dB with a mean air-bone gap of 16.2dB.
Conclusion: Surgical treatment of retraction pockets requires the selection of a suitable technique for the exploration of the middle ear, the restoration of the columellar effect and the prevention of recurrence. A long-term follow-up is required to assess the stability of the results.
Key-words: Retraction pockets, Children, Tympanoplasty, Audiometry.
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