Retracted Ear Drum Overview and Treatment

A retracted eardrum, also called middle ear atelectasis, is a tympanic membrane (eardrum) that is pulled deeper into the middle ear than is normal. This change in the shape of the eardrum is visible with a simple ear exam.

A retracted eardrum can be temporary, causing 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 in relation to the rest of the middle ear and describes the symptoms, complications, causes, and treatment of a retracted eardrum.

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This video has been medically reviewed by Chris Vincent, MD.

Anatomy of the Eardrum

The eardrum is a thin piece of tissue membrane that separates the middle and inner ear from the external ear. It has several functions, including transmitting and amplifying sound waves and protecting delicate ear structures.

The eustachian (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.

What Causes a Retracted Ear Drum?

Any condition that causes auditory tube dysfunction can affect the pressure inside the middle ear, eventually leading to a retracted eardrum. For example, if the auditory tube becomes clogged with mucus, not enough air is able to enter the middle ear, causing a change in pressure.

When there is negative pressure, a vacuum is created within the middle ear, causing the eardrum to get sucked in (retract). If severe, the negative pressure can even suck fluid into 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.

Recap

The auditory tube connects the throat to the middle ear and keeps the pressure in the middle ear balanced. If the tube becomes blocked, it can create a vacuum that retracts (sucks in) the eardrum.

What causes a retracted eardrum?

Verywell / Brianna Gilmartin

Symptoms and Causes

A retracted eardrum can cause ear pain, temporary hearing loss, and drainage of fluid from the ears. These typically improve when the underlying cause is treated.

The following conditions are associated with auditory tube dysfunction:

All of these conditions can block the flow of air into the middle ear and create negative pressure in the auditory tube.

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 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. This is described on a scale of 1 to 4, with level 1 being mild retraction and level 4 being an eardrum that is fully stuck in the auditory tube and middle ear.

Treatment

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

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 without treatment.

Treatment may include nasal decongestants or steroids to relieve congestion and inflammation or a course of oral antibiotics if there's a bacterial middle ear infection.

What Are Ventilation Tubes?

When fluid in the ears does not resolve on its own or causes severe symptoms or delays in a child's development, the surgical placement of temporary ventilation tubes (also called ear tubes) may be necessary.

These tiny tubes are placed in the eardrum, creating another pathway for ventilation of the middle ear. The short procedure is usually done as outpatient surgery.

While ventilation tubes will normalize pressure in the middle 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 or tonsils are preventing the auditory tube from draining, they may be removed.

Recap

A doctor may take a watch-and-wait approach for a retracted eardrum or proceed directly to treatments like oral antibiotics, nasal steroids, placement of a temporary ear tubes, or surgical removal of enlarged tonsils or adenoids.

Summary

A retracted eardrum occurs when the eardrum is pulled backward more than normal. If the auditory tube (also known as the eustachian 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.

A retracted eardrum can sometimes resolve on its own. If treatment is needed, it may include nasal steroids, oral antibiotics, the placement of a temporary ventilation tube in the eardrum, or the surgical removal of enlarged tonsils or adenoids. If not treated appropriately, a retracted eardrum can cause permanent hearing loss.

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.

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. 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

  3. 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.

  4. Stanford Medicine. Eustachian tube dysfunction.

  5. University of Michigan Health. Blocked eustachian tubes.

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.