Retracted Ear Drum

"My son keeps complaining that his ears hurt and that he hears loudly from time to time. His doctor says he has a retracted ear drum. What is this? "...This is a relatively common occurrence in children, especially during a cold. Before I explain what the exact cause is, let me describe the different parts of the ear. The ear drum, known as the Tympanic Membrane is thin, soft and very mobile or flexible. The tympanic membrane will move outward or inward depending on the type of pressure on it. In the case of an ear infection, the area behind the ear drum called the middle ear space, is full of fluid. This is positive pressure which pushes the eardrum outward causing it to bulge. When examining the ear with an otoscope, a doctor can actually see that the ear drum itself is bulging (pushed) outward and infected.

Why does this occur?

The middle ear area is connected to the nose by the Eustachian Tube. Whenever there is a negative pressure behind the eardrum because the Eustachian tube is blocked or not working well, the eardrum is sucked or "retracted"(pulled) backwards. This can be confirmed by examining a child's ear. This pulled back or retracted ear drum can cause an "increased hearing sensitivity". In other words sounds seem to be louder or there may even be pain in the ear itself because of the retraction.

How is a retracted ear drum treated?

There are no specific medications for this. However, we ask the child to perform a "Valsalva Maneuver" by holding his/her breathe and then tightening the body (as if one were pushing to have a bowel movement). This maneuver increases the pressure in the middle ear space behind the eardrum, and the problem is usually resolved. It is sometimes difficult to perform this maneuver so there are devices which help. One such device is a special balloon the child is asked to blow into through the nostril. This too can help resolve the retraction. Sometimes the ear drum is retracted because it is scarred from repeated past infections, but this is a much less likely cause.

Practical tips

We can get similar types of symptoms when we experience pressure changes typically occurring during airplane travel. Many people often have a change in their hearing during a flight ranging from sounds seeming louder than usual to muffled sounds. Many times there may be pain too. This is a result of the ear drum moving in response to the pressure changes especially during take-off, descent and landing. This may be relieved or even prevented by opening and closing the mouth, yawning or chewing gum especially during descent and landing. For younger children or infants, sucking on a bottle or pacifier may also help.