Retraction pockets and adhesive otitis media

Retraction pockets involve a loss of the original histological and anatomical structure, which is associated with the development of ossicular chain erosion, cholesteatoma formation, and potentially life-threatening complications from cholesteatoma. The prevalence of tympanic retractions in healthy children has been found to be 9.6% for the pars flaccida and 7.9% for the pars tensa. The pathogenesis features an inflammatory process of the tympanic membrane, such as otitis media with effusion or recurrent acute otitis media. Tympanic membrane retraction occurs when all or only one segment of the membrane collapses into the middle ear cavity. Such retraction could be asymptomatic and incidentally diagnosed via examination, looking for the presence of symptoms such as otorrhea or conductive hearing loss. There is no consensus on the indications, timing, or options for the adequate management of tympanic membrane retraction. The literature lacks a sufficient number of studies with high levels of evidence to support any surgical intervention over watchful waiting in the management of mild to moderate degrees of tympanic membrane retraction pockets. There is also no good evidence to favor one treatment over another. In this chapter, however, the criteria for diagnosis and different options for treatment are presented.