Management of Retraction Pockets of Pars Tensa and Pars Flaccida: A Systematic Review of Literature

Introduction: The treatment of retraction pockets and atelectatic tympanic membrane, both surgical and non-surgical, is highly variable amongst otologists and not always supported by good quality evidence. We undertook a systematic review of evidence to assess the quality of available evidence with the purpose of informing clinical practice. Materials and Methods: The following databases were systematically searched: PubMed, Embase, Centre for Reviews and Dissemination (DARE, NHS EED, INAHTA), NICE, Cochrane Database of Systematic Reviews, Cochrane Economic Evaluations, Cochrane Technology Assessment and Cochrane Central Register of Controlled Trials. The date of the last search was 07/03/2012 and no language limitation was applied. The identified studies were screened independently by the two reviewers using pre-defined inclusion criteria and validated quality assessment instruments. Randomised controlled trials and comparative studies were considered for inclusion. Results: The scoping search identified 589 papers which were screened for relevance. A number of 66 papers were judged potentially eligible and were analysed independently by the authors. Two randomised controlled trials and one cohort study met the inclusion criteria. The quality of studies and standard of reporting were poor. Discussion: The literature published on the management of retraction pockets and tympanic atelectasis is of low level of evidence and suffers from poor reporting standard. The studies reviewed were small and suffered from many methodological flaws. In the absence of high level of evidence, the authors propose to undertake a consensus exercise amongst experts using the Delphi technique.