I have recently learned that my 17 year old daughter has a serious problem with retracted eardrums -- retraction pockets -- eustachian tube dysfunction, and has already suffered some hearing loss. I have been advised that she needs prompt attention. How do I go about identifying and securing the best medical help available to her? I am insured through an HMO which I have the option of using "out of plan" as an indemnity plan. I live in the Baltimore -- Washington area.
Thank you for your help.
Answer -------------------
Tympanic membrane retractions are thought to occur because of chronic eustachian tube dysfunction which causes the air pressure in the middle ear to typically be lower than the ambient air pressure, leading in essence to a vacuum effect thereby pulling the ear drum inward.
With long term eustachian tube dysfunction and tympanic membrane retraction, actual "retraction pockets" can form. Such pockets may then accumulate debris and become infected, enlarge, adhere to structures in the middle ear, erode middle ear bones, or progress into the development of a cholesteatoma. A cholesteatoma is a tumor-like mass of skin that is trapped in the middle ear which can grow, erode bone, and become a source of chronic infection. Hearing loss can result either from the simple loss of efficient sound transmission caused by a tethered tympanic membrane or because of complications such as erosion of middle ear bones.
Initially tympanic membrane retractions can be treated with simple measures, such as nasal decongestants, topical nasal steroids, and frequent attempts at autoinflation ("popping") of the ears in an attempt to equalize air pressure. When this fails, tympanostomy tubes are frequently recommended to alleviate chronic pressure disequilibrium.
If the tympanic membrane retraction is severe enough to be adherent to middle ear structures, forms a "pocket" the depth of which cannot be seen, has caused erosion of an ossicle, becomes recurrently or chronically infected, or causes hearing loss, and the retraction has not responded to the above measures, more aggressive surgical intervention is generally recommended.
Typically, a procedure known as a tympanoplasty is done in which the ear drum is repaired using tissue from muscle, or cartilage surrounding the ear. If the middle ear ossicle(s) are damaged because of the retraction, the ossicles can be replaced in the same procedure (tympanoplasty with ossiculoplasty). If a cholesteatoma has formed in a deep retraction pocket, a tympanoplasty with mastoidectomy may be required to ensure complete removal of the cholesteatoma.
Most otolaryngologists do these types of procedures. You should be able to identify board-certified otolaryngologists in your area through your local county medical society. Some otolaryngologists limit their practices to otology (medical and surgical treatment of the ear), and such individuals are usually found only in large metropolitan areas.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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