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Retraction Pocket

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Middle Ear Diseases

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Abstract

Tympanic Membrane Retraction Pockets (TMRPs) refer to an otoscopic descriptive pathology of a retracted weak part of the tympanic membrane having lost its lamina propria and collapsed into the middle ear cavity.

A chronic inflammatory process with hypoxia in the middle ear is the underlying promoter of the pathologic condition. TMRPs are potential precursors in the pathophysiology of cholesteatoma formation. Therefore, a correct evaluation and an advanced work up of the TMRPs orient the otologist toward its adequate management, thus to prevent middle ear cholesteatoma.

The physiopathology of a retraction pocket is based on the understanding of the middle ear ventilation anatomy and the role of the mastoid in the pressure regulation. ME dysventilation syndromes either global or selective are clearly discussed. A comprehensive review of the recent literature regarding prevalence, etio-pathogenesis, and advanced findings of the molecular biology in TMRPs is presented.

A methodological assessment of the clinical features of a retraction pocket is designed.

This chapter includes an advanced CT-Imaging study offering pertinent information in relation to the aeration status of the ME compartments and mastoid, enabling the build up of several important clinico-radiologic correlations. Based on these correlations, a new methodology is established to predict the fate of a retraction pocket, thus to differentiate between safe and unsafe pockets and consequently to decide the surgical indication.

Different surgical procedures are presented to insure a free and permanent aeration of the middle ear, being the major factor to prevent the progress of a retraction pocket to cholesteatoma or to control its recidivism.

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Authors and Affiliations

  1. Lebanese University, Department of Otolaryngology, HNS Amoudi Center Boulevard Mazraa, Beirut, Lebanon

    Salah Mansour

  2. Aix-Marseille University, Marseille, France

    Jacques Magnan

  3. Department of Radiology, Middle East Institute of Health, Bsalim, Lebanon

    Karen Nicolas

  4. Lebanese University, Beirut, Lebanon

    Karen Nicolas

  5. Department of Otolaryngology, Hamad Medical Corporation, Weill Cornell Medical College, Doha, Qatar

    Hassan Haidar

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  1. Salah Mansour
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  2. Jacques Magnan
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  3. Karen Nicolas
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  4. Hassan Haidar
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Mansour, S., Magnan, J., Nicolas, K., Haidar, H. (2018). Retraction Pocket. In: Middle Ear Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-72962-6_7

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  • DOI: https://doi.org/10.1007/978-3-319-72962-6_7

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