55-year-old Male with Ear Discharge

A 55-year-old male with right ear discharge and hearing loss presents for evaluation at the ENT clinic. He has had recurrent acute otitis media (AOM) treated with multiple courses of antibiotics and a remote history of ventilation tube placement. The following image of his tympanic membrane (TM) is obtained.

Which of the following best describes his TM findings?

A. There is an acute-appearing defect in the pars tensa region
B. There is an acute-appearing defect in the pars flaccida region
C. There is a chronic-appearing defect in the pars flaccida region
D. There is a chronic-appearing defect in the pars tensa region

You can clearly see the defect as a large darkened circular area in the inferior portion of the TM. Anatomically, this is the center of the pars tensa region. Given the location and patient history of ventilation tubes, this is likely a result of failure to spontaneously heal following tympanostomy tube removal/extrusion.  The chronicity is supported by the patient history as well as the edges of the defect appearing smooth without signs of recent bleeding or other trauma. While spontaneous closure following removal of tubes is typical, several patient and ear drum characteristics impact persistent perforation, including use of long-term versus short-term tubes, age at time of removal and presence of tympanosclerosis.

WiscMed thanks Dr. Todd Morrow of Associates in Otolaryngology, West Orange, NJ for this interesting case originally posted on WiscMed April 29,2021.

Reference:

Brown C, Behar P. Factors affecting persistent tympanic membrane perforation after tympanostomy tube removal in children. Int J Pediatr Otorhinolaryngol. 2020 Mar;130:109779. doi: 10.1016/j.ijporl.2019.109779. Epub 2019 Nov 15. PMID: 31786523.