TITLE:
A Working Classification of Retraction for the Whole Tympanic Membrane
AUTHORS:
G. D. Barr
KEYWORDS:
Tympanic Retraction; Atelectasis; Otitis Media
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.2 No.4,
July
17,
2013
ABSTRACT: Objective: To formulate a reliable classification of tympanic membrane retraction which is
easy to use but capable of detecting small differences in retraction. Study Design: Prospective study. Methods: The classification was
developed from observations dividing the drum into 3 areas: the pars tensa
anterior to the malleus, type I, posterior to the malleus (subdivided into
upper and lower) type II, and attic type III. The subclassification on paper is
more complicated but using a database it is easy to use. The classification is
automatically calculated by the database which can also be converted to
numerical form. The classification also allows documentation of active disease
in retractions. Photographs of seven retracted ear drums were incorporated into
the database and ten otolaryngologists asked to classify them. Five were asked
to reclassify the retractions in the same way after 3 months. Results: Intra class correlation was
significantly high (>0.9) for pars tensa, attic, and for bony erosion. Cronbach’s
alpha values were also high (>0.9) in all groups. Retest values were
evaluated with Wilcoxon’s signed rank sum test establishing that there was no
significant difference in results. Conclusion: The classification shows reliabiliy and validity allowing detection of small
changes in tympanic membrane retraction especially affecting the pars tensa but
allows classification of the whole tympanic membrane.