What Causes a Retracted Ear Drum?

Female doctor looking into baby boy's ear
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If a doctor has told you that you have a retracted ear drum, you may be wondering what this means. Saying your eardrum is retracted is another way of saying that your ear drum, which is also called the tympanic membrane, appears to be sucked backward or concave. Medical professionals may also call a retracted ear drum middle ear atelectasis. To understand the conditions that may cause this, you must first understand a little bit about the ear drum and the normal physiology of the middle ear.

Anatomy of the Ear Drum 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 functions to ensure 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 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.

A retracted ear drum 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 ear drum to appear retracted. When only certain parts of the ear drum become retracted they are sometimes referred to as retraction pockets.

Symptoms and Causes of a Retracted Ear Drum

Many people with retracted ear drums 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 ear drum 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


The treatment used to alleviate negative pressure in the ear drum depends on the cause of auditory tube dysfunction. It 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 and 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 spontaneously 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.


Medscape. Eustachian Tube Function.  http://emedicine.medscape.com/article/874348-overview#a30

Medscape. Middle Ear, Tympanic Membrane, Infections.  http://emedicine.medscape.com/article/858558-overview

Otologytextbook.com. Retraction Pockets.  http://otologytextbook.net/retraction_pockets.htm

Society for Middle Ear Disease. Atelectasis of the Ear.  https://societyformiddleeardisease.org/atelectasis-ear-2/

The University of Arizona. Department of Surgery. Eustachian Tube Dysfunction.

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