Atelectatic Vs.

Adhesive OM
 thought to result mainly from long-standing eustachian tube dysfunction
 The middle ear gases also are exchanged with the middle ear mucosa. Bilateral diffusion between the
middle ear cavity and the blood may be an important factor in middle ear atelectasis because the gas
composition of the middle ear basically resembles that of venous blood.

Atelectatic OM Adhesive OM
Middle ear space Partial obliterated/completely Completely obliterated
T.M relation to ossicles +promontory T.M not adherent to the promontory and the ossicles adherent
Mucosal lining of middle ear is preserved Not preserved

 In patients with bilateral OME, 1.5% of untreated ears and 2% of ears treated with tubes had severe
atelectasis developed.
 It may be that repeated bouts of AOM lead to weakening and thinning of the membrane, which allows
atelectasis.
 Atelectasis and adhesive otitis media usually coexist with OME, although OME may resolve in these
ears, allowing aeration of the attic and mastoid, but leaving a collapsed middle ear. In extreme cases,
when hearing loss or ossicular erosion occurs, a myringoplasty for the reinforcement of atelectatic
tympanic membrane may be indicated.
 Retraction of the T.M may lead to erosion of:
 Long process of the incus.
 Stapes suprastructure.
 Sadé demonstrated that ears with a nonpneumatized mastoid may have a limited ability to buffer
pressure changes and will present as an atelectasis, a retraction pocket, or (eventually a
cholesteatoma) their reverse, a hyperectatic tympanic membrane.
 Sade four stages of tympanic membrane retraction:
1. stage I, retracted tympanic membrane; Slight retraction of ear drum
2. stage II, retraction with contact onto the incus; Retracted drum touching the incus or stapes
3. stage III, middle ear atelectasis; Tympanic membrane touching the promontory
4. stage IV, adhesive otitis media; Tympanic membrane adherent to the promontory
 Middle ear atelectasis may be reversible with ventilating tubes

© Summarized and modified by Dr. Diala Mardini, Dr. Mohammad Alsalem. For personal reading only.
Sade classification of Pars tensa retraction

© Summarized and modified by Dr. Diala Mardini, Dr. Mohammad Alsalem. For personal reading only.