Tympanic Atelectasis in Children and Early Surgical Approach: The Ferrara Experience

Objective: To assess functional and anatomic results of early surgical approach in a group of children, affected by atelectasis of the middle ear. Management of the tympanic membrane atelectasis still represent a challenging problem in paediatric patients, due to clinical application of different classifications, potential unfavourable evolution, different therapeutic options. Materials and Methods: Retrospective study of paediatric patients with a severe atelectasis and/or retraction pocket/s of the tympanic membrane evaluated and treated surgically between January 2002 and December 2009, c/o the Audiology Department of the University Hospital of Ferrara (Italy), a tertiary referral centre. Atelectasis of the middle ear was classified according to the Sadè classification by pre- and post-operative microtoscopy. Pre- and post-operative audiometric evaluation were compared. Results: The study group consisted fifty-four (54) ears (26 boys and 28 girls), with a median age at the time of diagnosis of 6 ± 3.8 years. All patients underwent myringoplasty with perichondrium or fascia under general anesthesia, via endomeatal approach in most cases. Pre-operative findings were, according to the Sadé classification: tympanic retraction with atrophy 53.7%, atelectasis with incudopexy 16.7%, severe atelectasis with rectraction pocket/s 29.6%. Cholesteatoma was detected intraoperatively in 16.7% of the cases (n=9). Post-operatively, at the last follow-up control, at 14 months after surgery on average, we registered a regular otoscopy in 46.3%, mild retraction in 42.6%, neotimpanic perforation in 3.7% of the cases. No deterioration of bone conduction thresholds was found following surgical intervention, neither iatrogenic sensorineural loss postoperatively. Conclusion: This study demonstrated that surgical intervention on middle ear atelectasis is a safe procedure and has no negative effects on hearing. Nonetheless, surgical intervention could allow tympanic atelectasis management, and, most importantly, early diagnosis of retro-tympanic cholesteatoma.