Sade Classification - Pars Tensa Retraction
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🩺 Sade's Classification of Pars Tensa Retraction
✅ Grade 1: Mild Retraction
- Minimal retraction of the tympanic membrane.
- Not in contact with the incus or any other middle ear structures.
- Loss of light reflex seen.
- Tympanic membrane still mobile.
✅ Grade 2: Contact with Ossicles
- Tympanic membrane now touches the long process of incus or stapes.
- Ossicular structures may appear more prominent on endoscopy.
✅ Grade 3: Middle Ear Atelectasis
- Retraction becomes severe, and the tympanic membrane is now in contact with the promontory.
- Key feature: The membrane still moves with Valsalva or suctioning (reversible atelectasis).
✅ Grade 4: Adhesive Otitis Media
- Tympanic membrane is plastered to the promontory.
- No movement on Valsalva or suctioning.
- Represents irreversible adhesive otitis media.
🔁 Grade 3 vs Grade 4 – Key Difference
| Feature | Grade 3 | Grade 4 |
|---|---|---|
| Contact | Tympanic membrane touches promontory | Tympanic membrane touches promontory |
| Movement on Valsalva | ✅ Present (moves) | ❌ Absent (plastered) |
| Also Known As | Middle ear atelectasis | Adhesive otitis media |
📌 Summary
The SADE classification gives insight into the severity and reversibility of pars tensa retraction:
- Early grades are mild and reversible.
- Later grades indicate more severe, potentially permanent damage.
Understanding and being able to draw and explain each stage is crucial for clinical practice and ENT exams.
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