A tympanic membrane retraction, or retracted eardrum, is a condition where the tympanic membrane, or eardrum, gets pulled toward the middle of your ear. The tympanic membrane is a thin layer of tissue found between your inner and outer ear. It’s responsible for transmitting sound vibrations to the bones in the middle ear, allowing you to hear.
What Causes a Tympanic Membrane Retraction?
One of the leading causes of a tympanic membrane retraction is Eustachian tube dysfunction. The middle ear is usually filled with nothing but air. Air pressure outside of the eardrum must remain equal to that in the middle ear. If an Eustachian tube issue changes that balance, it can produce a vacuum that starts pulling the eardrum toward the middle ear. A vacuum can also form because of an infection caused by bacteria making its way into the Eustachian tube.
Rapid changes in air pressure can contribute to the development of a retracted eardrum. Retraction pockets can form on only certain parts of the eardrum instead of the entire membrane. There are four stages of eardrum retraction:
- Level I retraction — There’s no contact with any of the bones of the middle ear.
- Level II retraction — The tympanic membrane contacts the middle ear bone.
- Level III retraction — The middle ear cavity starts to narrow because of the retracted eardrum.
- Level IV retraction — The retracted eardrum gets stuck in the middle ear space because of chronic inflammation.
Some people don’t feel any symptoms from a retracted eardrum. Others may have chronic issues and may experience:
- Pain in the ear
- A feeling of pressure or fullness in the ear
- Hearing loss
- Fluid in the ear
What Complications Can Result From a Tympanic Membrane Retraction?
Without treatment, a tympanic membrane retraction could lead to a ruptured eardrum. Signs that you may have a ruptured eardrum include ringing in the affected ear and nausea from vertigo. You should contact a doctor immediately if you believe you have a ruptured eardrum or experience persistent issues with your ears.
A ruptured eardrum may heal without additional treatment. If the condition persists for longer than six months, you may start having complications that include hearing loss, which typically lasts until the rupture heals. The size of your rupture and its location plays a role in how the condition affects your hearing. You may also find yourself dealing with chronic ear infections because bacteria continually makes its way inside the tear.
Another complication that could develop is a cholesteatoma, which is a cyst that forms in the eardrum retraction pocket. It starts as a build-up of skin and earwax, then spreads to the middle ear space or the mastoid bone located behind the ear. The eardrum usually sheds dead skin into the ear canal, which is what causes wax build-up. It’s not able to perform this function if it collapses, leading to cholesteatoma.
Signs of a cholesteatoma resemble that of a ruptured eardrum. That’s why you should see a doctor about any ear discomfort. It’s not possible to diagnose a cholesteatoma without removing the growth and examining it under a microscope.
Without treatment, the cholesteatoma could eat away at the bones that control your ability to hear, leading to permanent hearing loss. The resulting infection could spread to your inner ear or even the brain. You could end up with infections like:
- Meningitis
- Brain abscess
- Vertigo
- Facial paralysis
How Do You Treat a Tympanic Membrane Retraction?
Treatment for a retracted eardrum varies depending on the severity of the retraction and any resulting complications. Your doctor will likely keep you under evaluation to monitor your condition. The physician may prescribe antibiotic drops if you have a perforated eardrum or sees signs of an infection. If the hole doesn’t heal, the doctor may recommend sealing it with a patch or performing surgery.
If you have a cholesteatoma, then you will likely need to have surgery to remove the cyst. Your doctor may give you a course of antibiotics to deal with any infection that’s causing drainage. They may want to perform a CT scan to determine the extent of the disease. Depending on the severity of your cholesteatoma, the surgeon may need to rebuild your eardrum, your hearing bones, or remove the bone located behind your ear.
You may have to have a second surgery six to 12 months later. There may be some loss of hearing after the first surgery if there is a delay in rebuilding your hearing bones. The goal of cholesteatoma surgery is to leave you with a dry ear free of infection.