13 Year-Old with Decreased Hearing

A 13-year-old male presented to his pediatrician with concerns for decreased hearing. The patient has a history of chronic otitis media with effusion (OME) and had bilateral ventilation tubes placed 7 years ago. The WiscMed Wispr digital otoscope image of his right ear is attached.

Which statement is true?

A. The patient has a rupture of his eardrum.
B. The patient should be placed on antibiotics.
C. The patient has a retracted eardrum.
D. The patient has a normal eardrum.

This is a dramatic image of an ear with a retracted tympanic membrane (TM, eardrum). The retraction is so significant that the middle ear structures are readily visible. It’s analogous to a piece of Saran Wrap being placed over a chicken wing. Significant retractions of the TM can be caused by recurrent otitis media with effusion. Compare this eardrum to a normal eardrum here.

 A retracted eardrum can be confused with a ruptured eardrum. Generally, a ruptured eardrum would have portions of the TM that appear normal, and only the “ruptured” portion would appear abnormal. There is no indication for antibiotics for a retracted eardrum.

 The patient should be referred to otolaryngology (ENT) for further treatment.

 Key Learning Points

-Chronic otitis media with effusion can cause retraction of the tympanic membrane

-Significant retraction of the tympanic membrane can cause hearing loss

-Mild retractions resolve spontaneously; severe retractions require ENT evaluation.

WiscMed thanks Daniel Lapidus, MD, FAAP, Pediatric Director, MyCare Pediatrics, for this interesting case.

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