Tympanic Membrane Atelectasis

by Kevin Pederson

Tympanic membrane atelectasis is characterized by the inflammation or infection in the middle ear. The complication causes fluid buildup in the middle ear, and the tympanic membrane, a thin membrane that separates the middle ear and the ear canal, becomes retracted, thin and atrophic. The condition is also known as atelectatic or adhesive otitis media.

Symptoms


  • Earache
  • Loss of hearing
  • Acute suppurative otitis media (ASOM)
  • Moderate or mild deafness
  • Vibrations in the ear
  • Discharge from the ear (cholesteatoma)

Physical Signs


The investigation of the condition presents following physical signs:

  • Poor and sluggish movement of the tympanic membrane
  • Vascular dilatation
  • Amber or yellow appearance
  • Tympanic membrane dullness or thickening
  • Indrawn tympanic membrane and visible short process of the malleus

Causes


The causes of tympanic membrane atelectasis may include the following.

  • Negative Middle Ear Pressure: The blockage of the Eustachian tube, a narrow passage that joins the tympanic cavity with the nasopharynx and releases the pressure in the middle ear, causes the pressure build up in the ear. The condition results in the negative middle air pressure and the retraction of the tympanic membrane.
  • Tympanic Membrane Perforation: A hole in the tympanic membrane (eardrum) can lead to ear damage or chronic infection. The tympanic membrane separates the ear canal from the middle ear.
  • Surface Area Expansion in the Tympanic Membrane: The action of migration and proliferation of the new cells along the air canal can lead to increase of a retraction pocket so that the ear drum develops deep into the ear.

Diagnosis and Treatment


The diagnosis of the tympanic membrane atelectasis includes detailed physical examination and radiographic studies such as CT scans. In some cases of tympanic membrane atelectasis, an observatory period may be advised by the specialist, as the condition may stabilize by itself.

Nonetheless, the treatment of the tympanic membrane atelectasis can involve several procedures, given below, depending upon the symptoms and the underlying cause of the disease.

  • Injection of Ventilation Tubes: The ventilation tubes perform the function of eustachian tube and facilitate drainage and ventilation for the middle ear.
  • Nasal Treatment (adenoidectomy): The surgical procedure to remove adenoids, the nasopharyngeal tonsils, situated behind the throat, enhances the function of the middle ear. However, the medical opinion on the procedure is divided and contentious.
  • Myringoplasty: The surgical process involves repairing of the perforated tympanic membrane.
  • Eustachian Tube Surgery: The surgery of the eustachian tubes is performed to drain the fluid and to maintain the pressure equilibrium outside and inside the ear.
  • Retraction Pocket Surgery: The procedure involves excision of the retracted pocket, with or without the hep of the tympanostomy tube (grommet).
  • Tympanoplasty: The procedure entails the repair of the tympanic membrane (eardrum) and/or repair of the bones of the middle ear (ossicles).
  • Ossiculoplasty: The simultaneous restoration of the perforated tympanic membrane and adjustment of the small bones (ossicles) of the middle ear.
  • Mastoidectomy: The surgical process involves removal of skin growth or an infection behind the eardrum and the mastoid bone.
Some other treatment procedures for the tympanic membrane atelectasis include:

  • Facial recess
  • Aditus block
  • Mastoidotomy

Complications


The complications of the condition include:

  • Ossicular disruption culminating into conductive hearing loss (loss of hearing due to complications in the middle ear)
  • Behavioural problems such as learning problems, isolation
  • Infection spread beyond the membrane of the middle ear
  • Facial nerve paralysis
  • Ossicular lesions
  • Cholesteatoma (abnormal growth of cells at the back of the ear drum, causing severe damage to the middle ear and the ear drum)
Tympanic membrane atelectasis can cause severe physical and psychological disorders or complications. It is imperative to treat the disease at the early stage to avoid major developments that could lead to hearing loss and other physiological problems.

References:
  1. www.ncbi.nlm.nih.gov

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