Retracted Eardrum - Definition, Symptoms, Causes and Treatment

Tympanic Membrane Retraction

What is a retracted eardrum?

What is the role of tympanic membrane?

The eardrum is a membrane structure located between the middle ear and the outer ear. It has both barrier and hearing functions. Normally, the inside of the eardrum faces the middle ear cavity, while the outside faces the outer ear canal. In other words, the pressure differences between the middle ear and the outer ear cause the eardrum to move inward or outward. For example, as the plane rises, the external pressure decreases and since the middle ear pressure will be higher than the external pressure, it moves outward in the eardrum. The eustachian tube can passively evacuate air from the middle ear to the nasopharynx and passively equalize the pressure. Conversely, when the plane dives down or dives deep in the sea, the external pressure increases, and when the pressure in the middle ear is less than the external pressure, the eardrum stretches inward, towards the middle ear. In the meantime, swallowing motion or valsalva ameuras must be performed in order for air to enter the middle ear through the eustachian tube and equalize the pressure. In other words, it is not possible to increase the middle ear pressure passively. Considering this mechanism, in all diseases and conditions that affect the functioning of the eustachian tube, retraction in the eardrum can be expected as a result of pushing the eardrum inward.

Sometimes, a retraction area in the form of a pocket towards the middle ear occurs as a result of prolonged exposure to negative pressure in a limited area of the eardrum, and this situation is called "tympanic membrane retraction pocket". This also is same termed as "tympanic membrane atelectasis". Atelectasis of the tympanic membrane may occur as a permanent structural change in the eardrum after chronic otitis media with effusion. It is a problem that occurs as a sequelae due to the melting of the fibrous layer of the tympanic membrane as a result of the long-term effect of abnormal negative pressure.

Retracted eardrum symptoms

In patients with retracted eardrum, symptoms occur according to the amount of retraction. Small ossicles, which are attached to the eardrum and function with the effect of leverage in the transmission of the energy of sound waves to the inner ear, cannot work comfortably due to the decrease in their range of motion when the eardrum is pushed inwards, and in this case, an increasingly conductive type of hearing loss occurs. Over time, ossicles may become sclerosed, adhesion or melting of the eardrum towards the cochlea, deformation in the middle ear ossicles and puncture behind the ear can occur. Especially in patients with severe retraction and staying in this way for many years, deformation in the middle ear ossicles, sclerosis in the joints, elimination of the lift effect, and ear discharge after contact with water due to perforation in the membrane may occur. Especially in patients who have had eardrum retraction due to negative pressure in the middle ear for a long time, thinning and perforation of the eardrum may occur.

Retracted eardrum symptoms can be summarized as follows:

• earache
• feeling of stuffiness in the ear
• fluid flowing from the ear
• temporary hearing loss
• in more severe cases it can cause permanent hearing loss

If your ear is blocked while driving downhill fast, or if you have ear congestion and pain while the plane is descending, it would be beneficial to see an otolaryngologist. Because, in patients with retracted eardrums, it is much easier to experience severe ear pains and barotrauma in case of going downhill, diving, or descending with an increase in external pressure (since the eardrum is already retracted inward, there is no room for flexing from the outside to the inside).

Causes of retracted eardrum

The retracted eardrum is mainly due to eustachian tube problems, which are responsible for pressure equalization in the middle ear. When your eustachian tubes aren't working properly, the decrease in pressure inside your ear can cause your eardrum to collapse inward. In the following situations where the function of the eustachian tube is blocked or negatively affected, fluid accumulation in the middle ear and retracted eardrum may occur.

Common causes of eustachian tube dysfunction include:

• ear infection
• have a cleft palate
• structural causes that can cause nasal congestion, allergy, nasal polyps, mass lesions inside the nose
• upper respiratory infections
• enlarged tonsils and adenoids

How is retracted eardrum diagnosed?

Otoscopic ear examination is sufficient for the diagnosis of retracted eardrum. Usually, instead of normal eardrum structure and prominent light triangle reflection; The dull or light triangle is not visible and the membrane structure adhered to the ear ossicles below can be seen. Hearing tests and imaging methods may be required in patients with severe ear retraction.

Retracted eardrum treatment

Treatment is not required in all patients with retracted eardrums. It is ideal for an ear, nose and throat specialist to examine the treatment and to plan the treatment and follow-up according to the condition of the eardrum and hearing of the patient.

In patients with mild retraction in the eardrum, it can recover spontaneously when the pressure in the middle ear reaches normal camels. For example, after a smoker and a patient with allergic rhinitis ceases smoking and provides treatment of intranasal allergic reactions with appropriate medical treatment, the operation of the eustachian tube can be normalized and retraction in the eardrum can be eliminated.

This may take several months, so your doctor may recommend that you take a look at your symptoms before starting any treatment.

In more severe cases, a variety of treatments may be required to increase the air flow in your ear. In order to normalize the negative pressure in the middle ear, nasal treatments and oral decongestant medications may be useful.

Valsalva maneuver

Your doctor may also recommend performing a Valsalva maneuver to help normalize the pressure in your ears. You can do this as follows:

Closing your mouth and pinching and closing your nose, then breathing out towards the nose. This can be done for 10 to 15 seconds at a time. However, if the pressurized and rapid breathing is given towards the nose, the eardrum may be punctured by the sudden and rapid air escape to the ear while the nose is closed. It is best to do this under your doctor's direction to avoid further problems for your ears.

In the video above, during the Valsalva maneuver, increased pressure in the middle ear and the outward movement of the eardrum in a patient with a retracted eardrum is seen.

Otovent nasal balloon

Especially in children, the Valsalva maneuver is not very suitable in the treatment of retracted eardrums. It is very beneficial to inflate the balloons called OtoVent Nasal balloon from the nose.

If the retracted eardrum starts to put pressure on the bones of your ear and affect your hearing, you may need surgery. Surgical treatment is not very useful in patients with structural changes in the membrane and affected middle ear ossicles. However, one of the following procedures can be performed in patients who have just started ear retraction and where the above measures do not work:

Ventilation tube placement. If you have a child with frequent ear infections, their doctor may recommend placing ear tubes in their eardrums. Tubes are placed after a planned incision in the eardrum called a myringotomy. The tube allows air to enter the middle ear, which helps to stabilize the pressure (equalize the middle ear with the outside pressure).

Tympanoplasty. This type of surgery is used to correct a damaged eardrum. Your doctor will remove the damaged part of your eardrum and replace it with a small piece of cartilage from your outer ear. The new cartilage hardens your eardrum to prevent it from collapsing again.

Prognosis in retracted eardrum

Mild eardrum retractions usually cause no symptoms and resolve spontaneously within a few months. However, more severe withdrawals cause ear pain and hearing loss. In these cases, your doctor may plan a medical treatment (prescribe a decongestant) or recommend surgery.

Source links >> Retracted Eardrum: Symptoms, Causes, Diagnosis, and ... / Tympanic membrane: MedlinePlus Medical Encyclopedia Image / A Working Classification of Retraction for the Whole Tympanic Membrane

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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