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Clinical Challenges
October 20, 2008

Does Early Surgical Intervention of Middle Ear Atelectasis Improve Long-term Results and Prevent Cholesteatoma?

Author Affiliations

Author Affiliation:Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.



Arch Otolaryngol Head Neck Surg. 2008;134(10):1040-1044. doi:10.1001/archotol.134.10.1040

Hypothesis:Early Surgical intervention of middle ear atelectasis improves long-term results and prevents cholesteatoma.

Atelectasis of the tympanic membrane (TM) is a frequently encountered otologic abnormality, yet the treatment of atelectasis remains controversial. This controversy stems in part from the fact that the term atelectasismay refer to a variety of conditions that have very different clinical behavior. Some authors differentiate fibroadhesive otitis media or retraction pockets from atelectasis, whereas Buckingham1considered these conditions to be advanced stages of atelectasis. In addition, atelectasis of the pars tensa and pars flaccida clearly have different risks and surgical treatment. To evaluate clinical outcomes, Sadé and Berco2developed a separate staging system for pars tensa atelectasis that is widely used (Table). This grading system, however, does not account for the thickness of fibrosis or other factors that influence outcome, such as the degree of hearing loss or ossicular erosion.