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Tympanic membrane retraction pockets: Treatment, symptoms, advice and help

About tympanic membrane retraction pockets

A tympanic membrane retraction pocket is a part of the tympanic membrane that has been sucked inside by a negative pressure within the middle ear. There are three grades, the first is a simple early retraction not touching anything within the middle ear cleft, the second when it is draped over the small bones of the ears, and the third when it has retracted to the medial wall of the middle ear.

Tympanic membrane retraction pockets: Incidence, age and sex

The condition is generally found in young children and occasionally also be found in the adults as a result of glue ear during childhood.

Symptoms and signs of tympanic membrane retraction pockets: Diagnosis

Generally the patient complains of deafness and many of the symptoms associated with glue ear. In addition, they may have episodes of chronic infection when the pocket becomes infected.

Many of the signs are again similar to those of glue ear, i.e. a conductive hearing test on tuning fork tests and difficulty in the educational and social environment. In addition, on inspection by otoscope the pocket can be seen. It is most commonly sighted postero-superiorly but may also occur anteriorly within the tympanic membrane. Pure tone audiometry and tympanometry are useful and show conductive hearing loss.

Causes and prevention of tympanic membrane retraction pockets

Retraction pockets of the tympanic membrane are believed to be due to Eustachian tube obstruction or malfunction. It is the end product of a complication of glue ear. The risk of glue ear may be reduced by preventing exposure to environmental tobacco smoke, decreasing exposure to multiple respiratory pathogens, by delaying entrance to child care and vaccines.

Conjugated pneumococcal vaccine significantly reduces the risk.

Tympanic membrane retraction pockets: Complications

As the retraction pocket enlarges and therefore becomes infected more frequently, so a vicious cycle is set up with further enlargement occurring. There is also the prospect of damage to the small bones of the ear due to erosion particularly during attacks of infection. The main complications are those of erosion of the little bones of the ear (ossicles) leading to a conductive hearing loss. It may also develop into a skin retaining pocket or early cholesteatoma leading to erosion of other structures within the middle ear. It may therefore also develop into a full blown cholesteatoma extending back into the mastoid air cells.

Tympanic membrane retraction pockets: Treatment

Medical treatment includes careful observation, decongestants (though there is no effective evidence of benefit) and use of an Otovent balloon to auto-inflate the middle ear cleft. Surgical treatment includes grommet insertion and resection of the tympanic membrane with or without grafting. Occasionally mastoid aeration is also performed.