What Is a Retracted Eardrum?

A retracted eardrum is one that is pulled deeper into the middle ear than is normal. As a result, this thin piece of tissue (also known as the tympanic membrane) can no longer separate the middle and outer ear as it should.

Eardrum retraction, or middle ear atelectasis, can be temporary and cause symptoms such as muffled hearing. However, potentially serious complications can arise if the underlying cause isn't treated.

This article explains how the eardrum works and describes the symptoms, causes of eardrum retraction, and their treatment.

What Causes a Retracted Ear Drum?

Conditions that cause auditory (eustachian) tube dysfunction can lead to a retracted eardrum. They do this by blocking the flow of air into the middle ear and creating negative pressure.

Such conditions include:

• Acute otitis media (middle ear infection)
• Serous otitis media (fluid in the ears)
• Upper respiratory infection
• Chronic allergies
• Sinusitis (sinus infection)
• Enlarged adenoids or tonsils
• A prior ruptured eardrum
  

Ear Pressure and the Auditory Tube

Normally, the eustachian tube ensures that pressure in the middle ear is equal to that in the external ear. It does this by remaining closed except at certain times, such as when you yawn or swallow.

But the eustachian tube also clears mucus and other debris from the ears, allowing it to drain into the back of the throat.

That's not a problem if the tube remains clear. But if it gets clogged, not enough air is able to enter the middle ear, which causes negative pressure in the ear.

A vacuum is created within the middle ear, causing the entire eardrum or parts of it to get "sucked in" (retract). Areas of partial retraction are sometimes referred to as retraction pockets.

If severe, the negative pressure can even suck fluid into the middle ear.

Retracted Eardrum Symptoms

The eardrum has several functions, including transmitting and amplifying sound waves and protecting delicate ear structures.

Eardrum retraction can interfere with this and cause symptoms like:

• Ear pain
• Temporary hearing loss
• Drainage of fluid from the ears

Complications

If the cause of a retracted eardrum is not treated, the negative pressure inside the middle ear can lead to other problems including:

• Erosion (eating away) of the ear canal
• Erosion of the small bones in the ear (specifically the incus and stapes)
• Cholesteatoma, a skin-lined cyst that can invade the middle ear

All of these conditions can lead to varying degrees of permanent hearing loss.

The risk of complications is also directly related to the degree of eardrum retraction.

If your ear pain or hearing loss is worsening or you have fluid draining from your ear, contact your healthcare provider as soon as possible.

Treatment

Often, fluid in the ear will go away on its own and the eardrum will return to its normal position without treatment. It's also possible that treatment will be needed to remove the fluid and restore the eardrum's natural position.

The treatment used to correct a retracted eardrum depends on the root cause of your auditory tube dysfunction. Options include:

• Nasal decongestants to relieve congestion
• Steroids to reduce inflammation or congestion
• Oral antibiotics if there's a bacterial middle ear infection
• Ventilation tubes: These tiny tubes are placed in the eardrum temporarily, creating another pathway for ventilation of the middle ear. The short procedure is usually done as outpatient surgery.
• Eustachian tube balloon dilation, in which a tiny balloon is threaded into the eustachian tube through the nose and inflated to dilate open the eustachian tube."

While ventilation tubes will normalize pressure in the middle ear as long as they remain in place, the underlying cause for auditory tube dysfunction will still need to be addressed. For example, if enlarged adenoids or tonsils are preventing the auditory tube from draining, they may be need to be removed.

Summary

A retracted eardrum occurs when the eardrum is pulled backward into the middle ear. If the auditory tube is blocked in any way, the lack of airflow into the middle ear can cause a vacuum (negative pressure) that sucks the eardrum in.

A retracted eardrum can cause ear pain, temporary hearing loss, and drainage of fluid from the ear. Causes include infections of the middle ear or sinuses, allergies, enlarged adenoids or tonsils, or a prior ruptured eardrum.

Treatment for the underlying cause isn't always necessary. But when it is, permanent hearing loss can occur if it's not sought out.