---
title: "Sade Classification - Pars Tensa Retraction"
description: "Understand the Sade classification of pars tensa retraction, with schematic representations and endoscopic correlations."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/sade-classification"
categories: ["Otology", "Classifications and Gradings in ENT", "Drawings in ENT"]
video: "https://www.youtube.com/watch?v=u4tr4b81bms"
image: "https://media.theentresident.com/og-images/sade-classification.png"
---

# Sade Classification - Pars Tensa Retraction

Understand the Sade classification of pars tensa retraction, with schematic representations and endoscopic correlations. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=u4tr4b81bms

## 🩺 Sade's Classification of Pars Tensa Retraction

![Sade Classification of Pars Tensa Retraction](https://media.theentresident.com/post-images/sade-classification-pars-tensa-retraction.png)


### ✅ **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.

---

## About This Note

This free ENT note on Sade Classification - Pars Tensa Retraction was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/sade-classification

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Otology: https://www.theentresident.com/ent-notes-lectures/category/otology.md
- Classifications and Gradings in ENT: https://www.theentresident.com/ent-notes-lectures/category/classifications-and-gradings-in-ent.md
- Drawings in ENT: https://www.theentresident.com/ent-notes-lectures/category/drawing-in-ent.md

## About The ENT Resident

The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students.

Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself.

Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md

## Medical-use Boundary

The ENT Resident provides educational material for medical learning and revision. It does not provide patient-specific medical advice, diagnosis, or emergency care, and it is not a substitute for evaluation by a qualified healthcare professional.

## More Resources

- Learn about the Premium ENT Notes, preview a complete sample, and find purchase options: https://www.theentresident.com/premium.md
- Premium note for this topic, Sade Classification - Pars Tensa Retraction: https://theentresident.gumroad.com/l/fdhon
- Read student testimonials: https://www.theentresident.com/testimonials.md
- Contact The ENT Resident: https://www.theentresident.com/contact.md

---

A complete index of all pages on this site, with descriptions and markdown links can be found here: https://www.theentresident.com/llms.txt