1. Retraction Pocket

2. Definition
Retraction pocket is the invagination of tympanic membrane into the middle ear space
It is frequently a result of chronic OME or prolonged dysfunction of the Eustachian tube.
Chronic retraction pocket
Can form adhesions with surrounding structures
Increase the risk of infection
Accumulation of debris and epithelium, predispose to the development of cholesteatoma.

3. Causes Chronic inadequate Eustachian tube opening
Result in chronic negative pressure in the middle ear space and retraction as well as atrophy of the tympanic membrane.
Weakness of the Pars tensa after Injuries
to the tympanic membrane.
Increased tympanic membrane surface area
Certain Retraction Pockets can regress spontaneously

4. Signs and Symptoms
Most Retraction Pockets have minimal symptoms both in early or advanced stages.
Hearing loss associated with Retraction Pockets can also be insignificant even with advanced disease.
Permanent conductive hearing loss can result as a result of necrosis of the ossicles from being draped by the atrophic tympanic membrane

5. Diagnosis General Clinical Diagnosis
Pneumatic Otoscopy: help identify whether the retraction pocket is reversible (flexible vs fixed)
Audiology exam

6. Retraction Pocket
Otoscopy Appearance: clear external auditory canal leading to a retracted tympanic membrane. Note the retraction of the membrane around the malleus with a prominent lateral process. The membrane is draped around the incudostapedial complex noted slightly inferior and posterior to the short process of the malleus. R1

7. Retraction Pocket
Otoscopic appearance: Examination of the right ear shows clear external auditory canal with an intact tympanic membrane. The membrane is retracted at the pars flaccida (superior to the lateral process of the malleus). The red arrow denotes the superior orientation. R2

8. Retraction Pocket Otoscopic Appearance

9. Treatment Watchful waiting Tympanostomy tube
Adenoidectomy (improve Eustachian tube function)
Tympanic membrane reconstruction