Objective: In children with otitis media with effusion (OME), to investigat
e the incidence of, and any association, between retractions of the pars te
nsa and pars flaccida; to assess the effect of pars tensa and pars flaccida
retractions on the hearing: to investigate risk factors for retractions; a
nd to document the natural history of such retractions over a 12-week "watc
hful waiting" period.
Study Design: Prospective. observational study.
Setting: Sixteen departments of otolaryngology in hospitals in the U.K.
Patients: A cohort of 1.267 children aged 3.25 to 6.75 years with confirmed
OME. None had previously received surgical intervention.
Interventions: Follow-up over a "watchful waiting" period of 12 weeks.
Main Outcome Measures: Otoscopy and pure-tone audiometry.
Results: Retraction of the pars tensa to the incus or promontory occurred i
n 8% of the better-hearing ears and 10% of the poorer-hearing ears. Pars fl
accida retraction to the malleus or farther occurred in 4.5% of the better-
hearing ears and 5.5% of the poorer-hearing ears. Retractions were not asso
ciated with a longer history of hearing problems. Pars tensa or pars flacci
da retraction in association with OME did not materially affect the hearing
. Pars tensa retractions, followed up over a 12-week period, resolved in 69
% of the better-hearing ears and 65% of the poorer-hearing ears. In 14% and
10% of ears, respectively, the OME had also resolved.
Conclusions: There is minimal evidence to support the concept that pars ten
sa or pars flaccida retractions are a strong or relevant marker for the sev
erity or evolution of OME in children. Prospective studies over a longer pe
riod of follow-up are required to confirm this.