Summary
Retraction pockets of the tympanic membrane differ in localization, size, biological behaviour, pathogenesis and numerous other issues. It is yet uncertain under which conditions and how frequent retraction pockets turn into proliferative cholesteatoma. Therefore therapeutic options vary from "wait and see" to reconstructive surgery. We propose a selection of items which facilitate the indication for surgery. Although none of the criteria alone is sufficient, the combination may serve as a guideline for the treatment. "Pro's" for surgery are: Base of the retraction pocket not visible, conductive hearing loss more than 20 dB SPL, chronic otorrhea, poor mastoid pneumatization, children, retraction of Pars tensa, impaired ventilation, poor compliance. CT-scanning is of limited value for the decision surgery vs. "wait and see", whereas endoscopic control may justify postponing surgical treatment. In case surgery is performed, the attic bone should be reduced, so that the epithelial pocket can securely be overseen an removed. Perichondrium-Cartilage Compound Grafts are applied for the reconstruction the defect.
