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Jacob sadé, MD; Camil Fuchs, PhD; Michal Luntz, MD

Arch Otolaryngol Head Neck Surg. 1997;123(6):584-588.

Abstract
Objective
To assess whether a correlation exists between the degree of pars flaccida (PF) retraction and the degree of mastoid pneumatization.

Design
The degree of PF retraction was defined by means of an operating microscope and a pneumatic otoscope. Degree of mastoid pneumatization was assessed planimetrically, using mastoid x-rays.

Setting
Private otologic clinic.

Participants
A total of 595 ears, with intact pars tensa, of 332 adult patients.

Results
The degree of PF retraction was found to be inversely correlated to the level of mastoid pneumatization. Poorly pneumatized mastoids were associated with PF retractions. The poorer the pneumatization, the deeper the retraction. Well-pneumatized mastoids were associated with normal position of the PF.

Conclusions
This study lends further support to the possibility that the mastoid pneumatic system functions as a middle ear pressure buffer. This possibility gives further explanation as to why ears with poorly pneumatized mastoids tend to develop tympanic membrane retractions and perforations, incus necrosis, or retraction pocket cholesteatoma, while ears with a large pneumatic system are rarely at such risk.

Arch Otolaryngol Head Neck Surg. 1997;123:584-588

Author Affiliations
From the Ear Research Laboratory, Sackler School of Medicine and Bioengineering Department (Drs Sade and Luntz), and the Department of Statistics and Operations Research, Raymond and Beverly Sackler Faculty of Exact Sciences (Dr Fuchs), Tel-Aviv University, Tel-Aviv, Israel.