On otoscopy, a retraction pocket of the pars tensa is seen to have eroded the long process of the incus, with the pocket now lying over the promontory but not adherent to it. According to the Sade classification, this is:

• A Stage III ✓
• B Stage II
• C Stage I
• D Stage IV

Explanation

Sade classified pars tensa retraction into four stages: Stage I is a mild retracted drum, Stage II is retraction onto the incudostapedial joint, Stage III involves erosion of the incus or stapes superstructure, and Stage IV is adhesion of the drum to the promontory. Erosion of the incus places this patient at Stage III. The absence of fixation to the promontory excludes Stage IV, which is the key discriminating feature.

Reference: Scott-Brown's Otorhinolaryngology and Head and Neck Surgery, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.