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DrtBalu's Otolaryngology Online

 

Retraction pocket of Pars tensa of ear drum

 

Introduction:

Retraction pockets involving the pars tensa portion of the ear drum is caused by atrophy of that portion of the ear drum. This thinning of
the ear drum occurs due to loss of middle collagenous brous layer. This condition is commonly associated with chronic middle ear
pathology. In rare cases atrophy of the pars tensa portion of the ear drum could be caused by intense sni ng on the part of the patient..
Sni ng reduces the middle ear pressure causing retraction of the pars tensa portion of the ear drum.
Retraction pockets are more common in the postero superior part of the pars tensa of the ear drum. Two reasons have been attributed
to this feature:

1. This area is more vascular than other areas of ear drum, hence could be subjected to intense in ammatory reaction.

2. The middle brous layer in this area is incomplete, lacking the circular bers.

Long term effects of pars tensa retraction:

1. Progressive retraction of pars tensa may even cause xation of the atrophic segmentto the bony walls of the middle ear cavity.

2. Progressive retraction of pars tensa may cause erosion of ossicles. Commonest ossicle eroded being the long process of incus

3. A small protion of these retraction pockets may progress and become cholesteatoma.

Classi cation of pars tensa retraction pockets:

Initially Sade classi ed these retractions under two heads:

1. Atelectasis: This is de ned as diffuse retraction of the tympanic membrane towards the promontory.

2. Retraction pocket: This is de ned as focal retraction of pars tensa towards the attic.

Recent classi cation proposed by Sade:

Grade Title Description

1 Retracted ear Slight retraction of ear drum

Retracted drum touching the incus or

2 Severe retraction
stapes

Tympanic membrane touching the

3 Atelectasis
promontory

Tympanic membrane adherent to the

4 Adhesive otitis
promontory
 

Symptoms:

1. Variable hearing loss due to chronic infection of middle ear cavity or due to middle ear effusion.

2. Persistent hearing loss is a possibility if the long process of incus is eroded. In pure tone audiometry the hearing loss exceeds 60 dB.

3. Episodic or recurrent otalgia or otorrhoea may occur due to episodes of acute otitis media

4. Variable levels of eustachean tube patency may cause varying levels of deafness

Clinical features:

1. Ear drum appears retracted.

2. Handle of malleus appear prominent

3. There is apparant shortening of the handle of malleus

4. The ear drum mobility is restricted / absent on siegalisation

5. Cone of light appear distorted

Management:

1. Eustachean tube insu ation: May be useful in early cases.

2. Grommet insertion

3. Reinforcement tympanoplasty: In this surgical procedure, the retraction pocket is excised and grafting of the de cient ear drum is
performed using temporalis fasica graft.

 
 

Otoendoscopic image showing pars tensa retraction pocket

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