What Causes a Retracted Ear Drum?

A retracted eardrum is one that appears concave. Medical professionals may also call a retracted eardrum "middle ear atelectasis." To understand the conditions that may cause this, you must first understand a little bit about the eardrum, called the tympanic membrane, and the normal physiology of the middle ear.

Anatomy of the Eardrum and Middle Ear

The eardrum is a thin piece of tissue, extending from the auditory tube, which separates the middle and inner ear from the external ear. The majority of the eardrum is stretched tightly across the auditory tube but other parts of the tympanic membrane are more flaccid. The ear drum 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 or our environment. The auditory tube does this by remaining closed except at certain times such as when we yawn or swallow. The auditory tube also clears mucous 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 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.

A retracted eardrum is thought to occur when there is negative pressure in the middle ear.

This so-called "vacuum effect" can cause the entire eardrum or only parts of the eardrum to appear retracted. When only certain parts of the eardrum become retracted, they are sometimes referred to as retraction pockets.

Symptoms and Causes of a Retracted Ear Drum

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

Many people with retracted eardrums experience some hearing loss which often goes 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:

Is a Retracted Ear Drum a Bad Thing?

A retracted eardrum is a sign of auditory tube dysfunction and the underlying cause needs to be found and treated. If left untreated, 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 be as simple as using nasal decongestants or steroids to relieve congestion and inflammation or a course of antibiotics in the case of a middle ear infection. Fluid in the ears will sometimes resolve on its own.

If your symptoms are not too severe or bothersome, your doctor may choose to 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 inside of the auditory tube to keep it open and to allow for adequate drainage and ventilation of 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 concerning to hear that you or your child is having a problem inside the ear where you can't see it for yourself. Getting your symptoms checked is the first step to having the underlying problem addressed. Working with your health care provider, the next news you hear will hopefully be good news for your auditory health.

Was this page helpful?
Article Sources