What Is Atelectasis of Tympanic Membrane?
Atelectasis of the tympanic membrane, also known as the retracted tympanic membrane, is a condition in which the eardrum or the tympanic membrane is pulled in towards the middle ear. The tympanic membrane is a thin layer of skin between the outer ear and the middle ear. This thin tissue is responsible for transmitting vibrations to the tiny bony bones in the middle ear.
Atelectasis of the tympanic membrane can be temporary, which can cause symptoms such as muffled hearing, and when not treated, it can cause potentially serious complications.
What Causes Atelectasis of Tympanic Membrane?
The main cause of atelectasis of the eardrum is eustachian tube dysfunction. The eustachian tube is the tube that connects the throat to the middle ear and maintains pressure in the middle ear. The air pressure outside the eardrum is equal to the pressure in the middle ear. The middle ear is filled with air. So when there is any issue with the eustachian tube, it can affect the balance of pressure and produce a vacuuming of the middle ear. This vacuum created can suck the tympanic membrane toward the middle ear. A vacuum can also be created by bacterial infection making its way into the eustachian tube. This vacuum created can affect the entire tympanic membrane or cause a part of it to retract. When only certain parts of the eardrum are retracted, it is referred to as retraction pockets.
There are four stages of atelectasis of the eardrum:
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Level I Retraction - When there is no contact of the eardrum with any of the bones of the eardrum.
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Level Il Retraction - When the tympanic membrane contacts the bones of the middle ear.
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Level Ill Retraction - When the middle ear cavity starts to narrow because of the retracted eardrum.
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Level IV Retraction - When the retracted tympanic membrane gets attached to the middle ear space because of chronic inflammation.
What Are the Symptoms of Atelectasis of the Tympanic Membrane?
The atelectasis of the eardrum usually does not cause any symptoms, but when the retraction is severe enough to press the bones or other structures within the ear, it can cause;
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Earache.
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Fluid discharge from the ear.
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Temporary hearing loss.
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Feeling of pressure or fullness in the ear.
How Is It Diagnosed?
The diagnosis of atelectasis of the eardrum is made from the symptoms and the history of any recent ear infections. The specialist will examine the ear cavity using an otoscope, an instrument used to visualize inside the ear canal, and see if the ear canal is pushed away.
How Is It Treated?
The treatment of the atelectasis of the eardrum is done by an ENT (ear, nose, and throat) specialist. All retracted eardrum conditions do not require treatment. Mild retraction of the eardrum often resolves as the pressure in the middle ear returns to the normal level. For this, it may even take several months, during which the doctor will instruct to observe the symptoms for any change before starting with the treatment.
Severe cases of atelectasis require treatment to increase the airflow to the ear, which will help normalize the pressure and fix the retraction. This is done using nasal decongestants and steroids.
The doctor might also perform the Valsalva maneuver to relieve the pressure in the ears. One can do this by:
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Keep the mouth and nose closed.
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Try to breathe out, keeping the mouth and the nose closed.
One can do this for 10 to 15 seconds and do it under the supervision of a doctor so as to avoid further complications to the ear.
When the atelectasis starts to press the bones of the ear and affect hearing, then one might need surgery that involves one of the following procedures:
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Tube Insertion - In children with recurrent ear infections, the doctor will suggest inserting ear tubes into the eardrums. The tubes are placed during myringotomy, which involves making a cut in the eardrum and inserting the tube. This tube will help to stabilize the pressure in the middle ear by allowing airflow into them.
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Tympanoplasty - It is a surgery done to fix a damaged eardrum. In this procedure, the damaged part of the eardrum is removed and replaced with a piece of cartilage from the outer ear. This new eardrum will stiffen them, which will prevent them from collapsing again.
What Are the Complications?
When this condition is not treated, it can lead to a ruptured eardrum. The signs of a ruptured eardrum are ringing sounds in the ear and nausea from vertigo. A ruptured eardrum will heal on its own but if the condition persists for longer than six months, then one can have other complications like hearing loss which will last till the rupture is healed. The size and location of the rupture will decide how the condition will affect the hearing.
The other complication that could develop from this condition is a cholesteatoma which is a cyst that is formed in the eardrum retraction pocket. It starts as a buildup of skin and earwax which then spreads to the middle ear space or the mastoid process. When the eardrum is collapsed, it cannot shed earwax, leading to cholesteatoma. The signs of cholesteatoma are similar to a ruptured eardrum. Cholesteatoma, unlike ruptured eardrums, will need treatment at the earliest as it can destroy the bones that are responsible for hearing and lead to permanent hearing loss. The infection resulting from this could spread to the inner ear or to the brain. It can even cause infections like:
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Brain abscess.
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Facial paralysis.
Conclusion
Atelectasis of the eardrum occurs when the eardrum is pulled inwards more than normal. This condition can occur when an ear infection persists for a long time and results in the collapse of the eardrum to the middle ear cavity. When this condition is left untreated for a long time, it can cause other infections. If you experience any discomfort in the ear, always consult a doctor to rule out the possibility of any serious condition and to get the treatment at the right time to avoid further complications.
