Attic Retraction Pocket

This picture shows a severely retracted left eardrum with retraction pocket formation.

Attic retraction pocket.

Go to top long term retraction of the eardrum will cause erosion of the ear canal and forms a deep pocket. 1 attic retraction pocket cholesteatoma is clearly visualized white arrow. One can describe a retraction pocket as a condition where part of the tympanic membrane is drawn towards the middle ear space and lies deeper than a healthy part. Further progression of retraction pockets can cause destruction of the eardrum.

Skin material often accumulates in this pocket and becomes infected causing drainage and potential severe complications. A retraction pocket with little epitympanic erosion can be managed using a transmeatal approach with or without extended tympanoatticotomy. Eventually the pocket may trap skin forming a skin cyst or cholesteatoma. This is differentiated from an infected retraction pocket of the pars tensa or a retraction pocket cholesteatoma.

Stratified squamous epithelium may also be present in the middle ear as other clinical or pathological entities such as metaplastic islands of the mucosa in chronic ears with central perforations. Although attic retractions have previously been classified into grades 0 through iv it is often not possible to assign attic retraction pockets into a single specific category. Pockets may be formed in any part of the tympanic membrane but typically are located in epitympanum. For retraction pockets the meatal skin flap length must be at least 8 10 mm.

The eardrum comprises two parts the pars tensa which is the main part of the eardrum and the pars flaccida which is a smaller part of the eardrum located above the pars tensa. The ear drum has dropped further in and has worn through the middle hearing bone arrow 1 and is now lying against the inner wall of the middle ear space. Tympanic membrane retraction describes a condition in which a part of the eardrum lies deeper within the ear than its normal position. It is disappearing out of view arrow2 so skin may be collecting deeper in the ear.

The terms atelectasis or sometimes adhesive otitis media. There has been significant bone erosion of the ear canal wall above the eardrum. The retracted segment of eardrum is often known as a retraction pocket. The present study describes an improved classification system based on otoscopic and endoscopic visualization of the retraction pocket fundus the ossicular status in the attic degree of scutal erosion and the presence or absence of cholesteatoma.

Either or both of these parts may become retracted. An attic cholesteatoma is defined as an epidermoid cyst found in the attic.