Retraction Pockets and Adhesive Otitis Media

Adhesive otitis media (AdOM) is the condition in which a portion of the tympanic membrane (TM) inseparably adheres to anatomical structures in the middle ear cavity (MEC). This is usually preceded by tympanic membrane retraction pockets (RP) and atelectasis. As the RP progresses, the middle ear volume decreases and eventually the middle ear cavity is obliterated by atelectasis of the tympanic membrane. At this stage, the membrane adheres to the middle ear structures but can be elevated because the mucosal covering is preserved. Retraction pockets do not always progress to atelectasis. Inflammation of the middle ear mucosa is the basic underlying process of all these events. The clinical picture that occurs in a significant part of the patients is conductive hearing loss. Erosion of the long arm of the incus is the most common bony chain abnormality. Decision-making in the management of RP is a complex issue. There are no objective criteria to be considered when deciding between surgical intervention or close follow-up options. Improvement of ET function may be achieved by control of nasal and nasopharyngeal problems, repeated Valsalva maneuvers, autoinflation. Surgical management of RP includes balloon tuboplasty,myringotomy with tube, tympanoplasty and mastoid surgery. Adhesive otitis media (AdOM) occurs as an undesirable consequence of prolonged serous otitis media and ET dysfunction. It is often bilateral and is sometimes associated with cholesteatoma. RP and atelectasis should be treated appropriately before AdOM develops. Atelectasis is best treated with ventilation tubes. The best treatment strategy for AdOM is not agreed upon. Surgical options include elevation of the TM from the medial wall of the middle ear, support with a cartilage graft, and insertion of a ventilation tube by puncturing the cartilage graft. In patients with AdOM complicated with cholesteatoma, the best surgical option is canal wall-down mastoidectomy without removal of the adhesive tympanic membrane.