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Tympanic Membrane Retractions: Pathophysiology, Classification, and Management

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Textbook of Otitis Media

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Abstract

Tympanic membrane (TM) retractions, when moderate or severe, because they determine irreversible changes in the middle ear (ME), are considered chronic otitis media. They deserve special attention since their role in the formation of cholesteatomas is well defined. Anatomically, they can be of the pars flaccida (PF) or of the pars tensa (PT) of tympanic membrane and may be sectoral or diffuse.

It is believed that the formation of TM retractions is multifactorial. First, pars flaccida would be a region inherently susceptible to natural fragility due to the histological characteristics of its fibrous middle layer with loss of connective tissue and collagen bundles in this area. Second, it is believed that retractions of pars tensa would be the result of chronic inflammatory processes resulting from a continuum, triggered by a sustained tubal dysfunction.

The natural history of tympanic membrane retractions is that they can follow one of four destinations: resolution, stabilization, perforation, and keratin accumulation with cholesteatoma formation. Mechanisms responsible for the progression of retractions continue to be debated. Tubal dysfunction, impairing middle ear ventilation, remains an important factor in the evolution to cholesteatoma and will be discussed below. Also in this chapter, we will discuss the classifications to define severity of the retractions and their clinic and audiometric pattern.

Despite the controversies regarding the management of retractions, it is of knowledge that is needed to correlate the severity of otoscopic findings with the degree of conductive hearing loss, and presence or not of epithelial accumulation in order to define the need for an early surgical intervention. All these issues will be detailed below.

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Author information

Authors and Affiliations

  1. Department of Otolaryngology, Pontifical Catholic University, Porto Alegre, Rio Grande do Sul, Brazil

    Inesangela Canali

  2. Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Inesangela Canali, Letícia Petersen Schmidt Rosito & Caroline Catherine Lacerda Elias

  3. Department of Otolaryngology—Head and Neck Surgery, Porto Alegre Clinica’s Hospital, Porto Alegre, Rio Grande do Sul, Brazil

    Letícia Petersen Schmidt Rosito

  4. Department of Otolaryngology, Hospital Nossa Senhora da Conceição, de Porto Alegre (GHC), Porto Alegre, Rio Grande do Sul, Brazil

    Caroline Catherine Lacerda Elias

Authors
  1. Inesangela Canali
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  2. Letícia Petersen Schmidt Rosito
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  3. Caroline Catherine Lacerda Elias
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Editor information

Editors and Affiliations

  1. Department of Otolaryngology, Clínica Universidad de Los Andes, Santiago, Chile, USA

    Marcos V. Goycoolea

  2. Otolaryngology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Sady Selaimen da Costa

  3. Department of Otolaryngology, Tata Memorial Hospital, Mumbai, Maharashtra, India

    Chris de Souza

  4. Paparella Ear Head & Neck Institute, University of Minnesota, Minneapolis, MN, USA

    Michael M. Paparella

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Canali, I., Rosito, L.P.S., Elias, C.C.L. (2023). Tympanic Membrane Retractions: Pathophysiology, Classification, and Management. In: Goycoolea, M.V., Selaimen da Costa, S., de Souza, C., Paparella, M.M. (eds) Textbook of Otitis Media. Springer, Cham. https://doi.org/10.1007/978-3-031-40949-3_41

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  • DOI: https://doi.org/10.1007/978-3-031-40949-3_41

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