Background: The attitude of treatment of retraction pockets (RP) depends on several factors that include age of the patient, stage of the disease and patient's compliance. Silent forms usually do not need any surgery, although the presence of predisposing factors (craniofacial malformations, for example) and/or the young age could indicate a preventive surgical procedure. For the advanced stages, where periodical cumulation of debris occurs, surgery would seem to be mandatory.

Material and Methods: A randomized, longitudinal study took into consideration the Stage II RP that were either treated by a surgical procedure or simply observed for a period of two years. Surgery consisted in an endaural approach epitympanectomy with scutum reconstruction (tragal cartilage).

Results: All the operated cases showed a permanent healing condition with stable hearing function. Nearly half of the “observation group” showed instead deepening of the pocket that in one case even ended up with perforation. In none of the study patients a real cholesteatoma was observed.

Conclusions: A preventive surgery is to be preferred in all Stage II RP. In fact, even if in some of the patients it could remain stable over the time taken into consideration (2 years), the possibility of occurrence of a more severe stage, ending up potentially to cholesteatoma, would represent a reasonable choice in order to avoid in the future more complex surgical procedures and all related possible complications.