Sade Classification - Pars Tensa Retraction

Otology Classifications and Gradings in ENT

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🩺 Sade's Classification of Pars Tensa Retraction

Sade 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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