The Natural History of Asymptomatic Deep Pars Tensa Retraction.

OBJECTIVES: The aim of this study was to quantify the natural behavior of asymptomatic deep pars tensa retraction in both adults and children.

MATERIALS AND METHODS: Asymptomatic pars tensa retraction pockets that contacted the promontory were included. Persistently symptomatic pars tensa retraction, pars tensa retraction that did not contact the promontory, patients with attic retraction pockets and patients with cholesteatoma were excluded. Patients were followed up annually and were eliminated from the study if they required active intervention or recovered so that their ears were persistently ventilated with no contact of the tympanic membrane to the promontory. Outcome variables included surgical intervention, surgical intervention for cholesteatoma, and spontaneous improvement and were studied using the life table method.

RESULTS: In total, 64 children and 25 adults were enrolled, of whom 19 children and five adults required intervention and five children and two adults developed pars tensa cholesteatomas. No significant difference was observed between children and adults. In total, three children, but no adults, developed attic cholesteatomas without progression of the pars tensa disease. Furthermore, the ears of 20 children, but not even one adult ear, returned to normal over the 10-year study period.

DISCUSSION: Most retracted adult ears did not change. Over 10 years, the most common finding in children was the return of their ears to normal. Ear of all children recovered during the second decade. Deterioration to form cholesteatoma was not influenced by age. Attic cholesteatoma without the progression of pars tensa disease was observed in children, but not in adults.