Retraction Pocket Definition • Retraction pocket is the invagination of tympanic membrane into the middle ear space • It is frequently a result of chronic OME or prolonged dysfunction of the Eustachian tube. • Chronic retraction pocket • Can form adhesions with surrounding structures • Increase the risk of infection • Accumulation of debris and epithelium, predispose to the development of cholesteatoma. Causes • Chronic inadequate Eustachian tube opening Result in chronic negative pressure in the middle ear space and retraction as well as atrophy of the tympanic membrane. • Weakness of the Pars tensa after Injuries to the tympanic membrane. • Increased tympanic membrane surface area • Certain Retraction Pockets can regress spontaneously https://s-media-cache- ak0.pinimg.com/originals/47/a5/0c/47a50ce b07d2d89f6987ff0870d9e4fb.jpg Signs and Symptoms • Most Retraction Pockets have minimal symptoms both in early or advanced stages. • Hearing loss associated with Retraction Pockets can also be insignificant even with advanced disease. • Permanent conductive hearing loss can result as a result of necrosis of the ossicles from being draped by the atrophic tympanic membrane Diagnosis General • Clinical Diagnosis • Pneumatic Otoscopy: help identify whether the retraction pocket is reversible (flexible vs fixed) • Audiology exam Retraction Pocket Otoscopy Appearance: clear external auditory canal leading to a retracted tympanic membrane. Note the retraction of the membrane around the malleus with a prominent lateral process. The membrane is draped around the incudostapedial complex noted slightly inferior and posterior to the short process of the malleus. R1 Retraction Pocket Otoscopic appearance: Examination of the right ear shows clear external auditory canal with an intact tympanic membrane. The membrane is retracted at the pars flaccida (superior to the lateral process of the malleus). The red arrow denotes the superior orientation. R2 Retraction Pocket Otoscopic Appearance http://otitismedia.hawkelibrary.com/albums/re http://otitismedia.hawkelibrary.com/albums/re traction/8_2.sized.jpg traction/8_1.jpg Treatment • Watchful waiting • Tympanostomy tube • Adenoidectomy (improve Eustachian tube function) • Tympanic membrane reconstruction.