Retraction Pocket; Etiology And Modified Single staged Surgical Management
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Retraction pocket is medial displacement of tympanic membrane. It is . not uncommon disease in Egypt Some pockets may remain stable and unchanged, and others may resolve spontaneously or deteriorate and progress to cholesteatoma formation. We have studied 30 cases of retraction pockets and have attempted to find out the etiology as well as the most effective treatment in such cases. Though over the years along with a dysfunctional eustachian tube, a sclerotic mastoid has been implicated as one of the causes of Retraction Pockets, we in our study have seen a large sized mastoid antrum (beyond 2 mm of Lateral Semicircular Canal) as a consistent feature in most of our cases. This was subjectively assessed as a surgical finding in ympanoplasty with mastoidectomy and objectively assessed by a High Resolution Computed Tomography(HRCT)of the temporal bone. We have found that a modified single- staged procedure in the form of tympanoplasty with canal wall down mastoidectomy with the use of 5 to 6 pieces of 1-0 chromic catgut in the middle ear (instead of the more conventionally used silastic) is the most effective in preventing the recurrence of retraction pockets. Also, this procedure offers an acceptable solution to those patients who live in rural areas (like Kalubia) where their follow up is poor.