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DrtBalu's Otolaryngology Online

 

Classi cation of pars accida retraction pocket

 

Introduction:

Pars accida retractions have a vital role to play in the pathophysiology of cholesteatoma. Tos et al classi ed pars accida retraction in
to four stages.

Stage I: Pars accida is dimpled and is more retracted than normal. It is not adherent to the malleus.

Figure showing Toss stage I retraction

 
Stage II: In this stage the retraction pocket is adherent to the handle of malleus. The full extent of the retraction pocket can be clearly
seen.

Figure showing Toss stage II retraction pocket

Stage III: In this stage part of the retraction pocket may be hidden. There may also be associated erosion of the outer attic wall
(scutum).

Figure showing Toss stage III retraction pocket

Stage IV: In this stage there is de nite erosion of the outer attic wall. The extent of the retraction pocket cannot be clearly seen as most
of it are hidden from the view.

Figure showing Toss stage IV retraction pocket

This classi cation described by Toss is fairly simple to apply, the only di culty being the di culty in making a distinction between
stages 3 and 4. Hence for practical purposes these two stages are grouped together.