Retracted Eardrum

Eardrum, also known as the tympanic membrane, is a thin membrane which enables our ears to perceive sounds. Retraction of eardrum means its displacement to a more inner portion than its actual location. The tympanic membrane typically consists of two parts, the pars tensa and the pars flaccida. Pars tensa is the main part of the tympanic membrane while the pars flaccida is a small portion lying above the pars tensa. Either of these or both may be retracted. Generally a retracted eardrum is caused due to infections. However, it can also be caused due to a sudden change of atmospheric pressure.

This condition can be seen in either children or adults. However, the occurrence of this condition is more commonly seen in children.

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Pathogenesis:

The various reasons due to which retracted eardrum can be present include:

Negative pressure in the middle ear

This is a simple concept where the middle ear pressure falls down and gets lesser than that of atmospheric pressure. This leads to the sucking of tympanic membrane into the middle ear space. This less pressure in the middle ear may be due to inadequate opening of the Eustachian tube.

Greater surface area of tympanic membrane

The body cells have a tendency to multiply and replace the old cells with new ones. In case of eardrum, this process is unusual. If they multiply, they start proliferation over the ear canal surface and thus the surface area of the membrane is increased. In such case, the eardrum gets retracted into the ear canal.

Weakened tympanic membrane

The pars tensa portion is strengthened by collagen fibres at its centre. This layer can be weakened in the postero-superior quadrant which can cause retraction. Also, pars flaccida in not stiff and it does not contain collagen fibres. So pars flaccida is more prone to retraction than pars tensa.

Causes:

Retracted eardrum can be caused due to one or more of the following factors:

  • Otitis media i.e. fluid in the ears
  • Middle ear infection
  • Rupture of the eardrum, which has not been healed properly
  • Auditory tube or Eustachian tube dysfunction

Retracted Eardrum – Symptoms

The most important symptom of this condition is increased sensitivity to hearing and sounds. The affected individual perceives sounds at a louder level than what they actually are. This sensation is similar to that of the one which is encountered in flights due to decrease in atmospheric pressure.

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The affected individual may also feel pain in the ear.

Diagnosis:

Infections of the ear are diagnosed by an ENT specialist, using an instrument known as the otoscope, which enables the clinician to look inside the ear without causing damage to the internal structures. This instrument helps in assessing whether the eardrum is retracted, protruded or infected.

Complications

If untreated for a longer time, this condition may give rise to retraction pockets in the middle ear. These pockets will act as a source of debris lodgement, which can further give rise to infection in this area. The infection in such case will convert to chronic infection because of late diagnosis and treatment.

This can also lead to cholesteatoma. This is a condition characterised by development of soft tissue mass in the middle ear space. This soft tissue mass presents itself as a cyst. This cyst can cause serious damage to the tympanic membrane. A big mass of such type in the middle ear can also lead to erosion of the bones of middle ear, which can progressively lead to hearing loss.

Retracted Eardrum -Treatment

Most cases of retracted eardrum do not require any specific treatment. In majority of the cases, the Eustachian tube manages to balance the pressure and rectify the condition. However, if the condition does not resolve by itself in some time, it is advised to consult a specialist for its treatment. Referring to medical treatment will give you good results in short time and will also treat the pain and infection from the ear canal.

Various treatment options include:

  • Blocked Eustachian tube may be due to infections, allergies or sinusitis. This can be very well treated with some home remedies and medications. Antibiotic drops, warm compression, nasal decongestants and painkillers may be helpful.
  • Another technique is the ‘valsalva maneuver’. This technique involves the holding of pressure similar to that when a person is trying to stimulate bowel movement by applying pressure. This causes an increase in the pressure in the mouth and therefore in the Eustachian tube, causing equalisation of pressure from both sides.
  • Frequent yawning can also be helpful as it will increase the pressure inside the mouth, which can help in equalising it with the external pressure.
  • A tympanostomy ear tube is used to remove fluids from the middle ear. In severe cases, the use of such a tube for the removal of fluids may be required.
  • Some surgical methods are also applied in cases of cholesteatoma.
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