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Tympanic Membrane Retraction - Causes, Symptoms, Stages, and Treatment

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Tympanic membrane retraction is when the eardrum or tympanic membrane gets pulled or retracted towards the middle part of the ear.

Written by

Dr. Osheen Kour

Medically reviewed by

Dr. Laxmi Narasimha G

Published At June 2, 2023
Reviewed AtFebruary 27, 2024

Introduction:

The tympanic membrane is a tissue layer between the ear's outer and inner parts. The membrane helps a person to hear the sound by sending vibrations to the middle ear. Tympanic membrane retraction arises due to the formation of a refraction pocket in the middle ear cavity. The condition occurs mainly due to eustachian tube dysfunction, which causes negative pressure in the middle ear. Tympanic membrane retraction is the most prevalent in pediatric patients and can cause various acute symptoms that may or may not require any treatment. However, in some severe cases, permanent hearing loss can also occur if tympanic membrane retraction is not treated timely. Therefore, a person experiencing initial symptoms should consult the doctor for proper management and guidance to treat this condition. The available treatment options may include eustachian tube surgery, retraction pocket surgery, tympanoplasty, adenoidectomy, increasing middle ear pressure, and or placement of ventilation tubes in the ear canal.

What Are the Causes of Tympanic Membrane Retraction?

Eustachian tube dysfunction is the primary cause of tympanic membrane retraction. However, it can also be caused by the following conditions.

  • Middle ear infection or acute otitis media.

  • Upper respiratory infection.

  • Enlarged tonsils or adenoids.

  • Sinus infection or sinusitis.

  • Fluid buildup in the ear or serous otitis media.

  • Ruptured eardrum.

  • Chronic allergies.

What Are the Symptoms of Tympanic Membrane Retraction?

The symptoms of tympanic membrane retraction are:

  • Temporary hearing loss.

  • Ear pain.

  • Fluid drainage from the ears.

  • Permanent hearing loss in severe cases.

What Are the Stages of Tympanic Membrane Retraction?

The stages of tympanic membrane retraction are:

  • Level I Retraction- In this, the bones of the middle ear are not in contact with the tympanic membrane.

  • Level II Retraction- In this, the tympanic membrane is connected to the missile ear bones.

  • Level III Retraction- The retracted eardrum causes the narrowing of the middle ear cavity.

  • Level IV Retraction- The chronic infection in the ear causes the retracted tympanic membrane to get stuck in the middle ear cavity.

What Are the Factors That Cause Tympanic Membrane Retraction?

The factors that cause tympanic membrane retraction include:

  • Negative pressure buildup in the middle ear can cause the eardrum to get retracted and sucked between the middle ear cavity.

  • The surface area of the tympanic membrane also increases sometimes due to the proliferation of the cells, which causes the widening of the retraction pocket and, thus, causes the expansion of the eardrum to get deeper into the middle ear cavity.

  • Tympanic membrane retraction can also occur due to the weakening of the tympanic membrane.

How Is Tympanic Membrane Retraction Diagnosed?

The doctor diagnoses the tympanic membrane retraction by examining the signs and symptoms such as ear infections, ear pain, etc. They also examine the ear through an otoscope device to look inside it and check if the eardrum is being pushed into the middle ear.

How Is Tympanic Membrane Retraction Treated?

Tympanic membrane retraction treatment usually depends on any underlying complications and the severity of the eardrum retraction. Therefore, the doctor mainly treats the condition by keeping the patient under observation and prescribes antibiotic ear drops for ear infections and perforated eardrums. Eustachian tube dysfunction or a hole in the eardrum may need surgical or patch treatment to fill the hole if it does not heal on its own. In addition, if a person has cholesteatoma, a surgical method to remove the cyst is advised, along with antibiotic therapy to treat the infection that causes drainage. The surgery depends on the condition, and the doctor may need to reconstruct the hearing bones and eardrums or remove the bone behind the ear.

A person needs second surgery after 6 to 12 months as the delay in reconstructing the hearing bone can cause hearing loss in a person after the first surgery. Therefore, cholesteatoma surgery helps in treating ear infections in person. The doctor also recommends tympanoplasty to treat damaged eardrums and tube insertion in the ear canal through myringotomy for treating eustachian tube dysfunction.

What Are the Complications Associated With Tympanic Membrane Retraction?

The complications associated with tympanic membrane retraction are as follows:

  • It can cause a rupture of the eardrum, which can cause symptoms such as vertigo, ringing in the ear or tinnitus, and nausea. In addition, the ruptured eardrum can cause hearing loss if the condition does not heal within six months.

  • A cyst in the eardrum called cholesteatoma is a complication due to tympanic membrane retraction. The condition arises due to the buildup of earwax or skin, which can spread to the mastoid bone or middle ear space. Cholesteatoma occurs when the eardrum cannot shed dead skin in the ear canal, and wax build-up does not occur.

  • Cholesteatoma can lead to permanent hearing loss if not treated on time. The ear infection can also lead to vertigo, meningitis, facial paralysis, and brain abscess.

What Is the Differential Diagnosis for Tympanic Membrane Retraction?

  • Otitis externa.

  • Posterior stroke.

  • Acute otitis media.

  • Neoplasms of the ear or brain.

  • Auricular hematoma.

  • Labyrinthitis.

  • Ramsay hunt syndrome.

  • Traumatic otorrhea.

  • Perilymphatic fistula.

  • Bullous myringitis.

Conclusion:

Some cases of tympanic membrane retraction cause mild or no symptoms and can get resolved or healed within a few months. However, severe cases of tympanic membrane retraction may require surgical treatment or decongestants, as it can cause permanent hearing loss and frequent ear pain. In addition, the condition can further exaggerate and affect the ear bone causing erosion and leading to cholesteatoma and other complications. Tympanic membrane retraction is very common and usually occurs in one ear. The condition rarely occurs in both ears and is common in children with cleft palate but can also occur in adults. Therefore, a person should consult the doctor immediately to avoid significant consequences such as permanent hearing loss. Parents should also take doctors' advice if they find any symptoms of tympanic membrane retraction in their children to improve their quality of life which can be affected due to this defect.

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Dr. Laxmi Narasimha G
Dr. Laxmi Narasimha G

Otolaryngology (E.N.T)

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