Retracted Ear Drum Overview and Treatment

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A retracted eardrum, also called middle ear atelectasis, is an eardrum that is pulled deeper into the ear canal. It can be temporary, causing symptoms such as hearing loss, and complications can develop if the cause isn't treated. This change in the shape of the tympanic membrane (eardrum) is visible with a non-invasive ear exam. This article describes the symptoms, complications, causes, and treatment of a retracted eardrum.

Anatomy of the Eardrum and Middle Ear

The tympanic membrane is a thin piece of tissue that separates the middle and inner ear from the external ear. The majority of the eardrum is stretched tightly across the Eustachian tube (auditory tube, ear canal), and other parts of the tympanic membrane are more flaccid.

The eardrum has several functions—including the transmission and amplification of sound waves and the protection of delicate ear structures.

The auditory tube ensures that pressure in the middle ear is equal to the pressure in the external ear. The auditory tube does this by remaining closed except at certain times, such as when we yawn or swallow. The auditory tube also clears mucus and other debris from the ears and allows it to drain into the back of the throat.

Any condition that causes auditory tube dysfunction can affect the pressure inside of the middle ear. For example, if the auditory tube becomes clogged with mucus or other debris, adequate air is unable to enter the middle ear and proper ventilation of the ear is impaired.

What causes a retracted eardrum?
Illustration by Brianna Gilmartin, Verywell

Symptoms and Causes

A retracted eardrum often causes some hearing loss or ear pain. These often go away with adequate treatment. Other symptoms vary, depending on the cause of eardrum retraction.

The following conditions are associated with auditory tube dysfunction and may cause a retracted eardrum:

A retracted eardrum is thought to occur when there is negative pressure in the middle ear. This vacuum effect can cause the entire eardrum or parts of the eardrum to appear retracted. When only certain parts of the eardrum become retracted, they are sometimes referred to as retraction pockets.

Complications

A retracted eardrum is a sign of auditory tube dysfunction and the underlying cause needs to be identified and treated. If it's not untreated, the negative pressure inside the middle ear can lead to other problems including:

  • Erosion of the ear canal
  • Erosion of the small bones in the ear (specifically the incus and stapes) and possibly permanent hearing loss
  • Cholesteatoma

Treatment

The treatment used to alleviate negative pressure in the eardrum depends on the root cause of your auditory tube dysfunction.

Treatment may include nasal decongestants or steroids to relieve congestion and inflammation or a course of antibiotics if there's a bacterial middle ear infection. Fluid in the ears will sometimes resolve on its own.

If your symptoms are not too severe or bothersome, your healthcare provider may wait and see if it goes away spontaneously.

In other cases, such as fluid in the ears that does not resolve on its own or that causes severe symptoms or delays in a child's development, the surgical placement of ventilation tubes may be warranted.

These tiny synthetic tubes are placed in the tympanic membrane, bypassing the blocked Eustachian tube and ventilating the middle ear. The short procedure is usually done in a same-day surgery setting.

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

A Word From Verywell

It's important not to ignore symptoms of a retracted eardrum. A retracted eardrum can usually be identified with a simple, non-invasive exam. Treatment can resolve your symptoms and prevent complications.

Frequently Asked Questions

  • What is negative pressure in your ear?

    Negative pressure occurs when the eustachian tube, which runs between the middle ear and the upper throat, is not working well. A vacuum develops behind the eardrum, causing it to collapse inward. 

  • Why do my ears get stuffy when I have a cold?

    The ears are connected to the throat and nasal passages. Infections in those areas travel into the middle ear and cause swelling in the eustachian tubes. Then the tubes aren't able to open fully, limiting your hearing and possibly causing some pain.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Danner CJ. Middle ear atelectasis: what causes it and how is it corrected?. Otolaryngol Clin North Am. 2006;39(6):1211-9. doi:10.1016/j.otc.2006.09.002

  2. Llewellyn A, Norman G, Harden M, et al. Interventions for adult Eustachian tube dysfunction: a systematic review. Southampton (UK): NIHR Journals Library; 2014 Jul. (Health Technology Assessment, No. 18.46.) Chapter 1, Background.

  3. Redaelli de zinis LO, Nassif N, Zanetti D. Long-term results and prognostic factors of underlay myringoplasty in pars tensa atelectasis in children. JAMA Otolaryngol Head Neck Surg. 2015;141(1):34-9. doi:10.1001/jamaoto.2014.2804

  4. Stanford Medicine. Eustachian tube dysfunction.

  5. University of Michigan Health. Blocked eustachian tubes. Updated December 2, 2020.

Additional Reading
  • Medscape. Eustachian Tube Function.

  • Medscape. Middle Ear, Tympanic Membrane, Infections.

  • Otologytextbook.com. Retraction Pockets.

  • Society for Middle Ear Disease. Atelectasis of the Ear.