Sade Classification - Pars Tensa Retraction

🩺 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

📌 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.