30 year-old with Ear Fullness

A 30-year-old female complains of ear fullness. She had tympanostomy (ear ventilation) tubes placed several months ago for recurrent otitis media with effusion (OME). The following image was obtained with the Wispr digital otoscope.

What is the next step in management?

A. No action required
B. Urgent consult to otolaryngology (ENT) for foreign body removal
C. Begin a short course of otic steroids
D. Begin a short course of oral antibiotics

The patient has an extruded tympanostomy (also known as ear or ventilation) tube. Ear tubes are placed to drain the middle ear space of fluid in cases of chronic acute otitis media (AOM) or otitis media with effusion (OME). The tubes function to both drain fluid from “behind” the eardrum and to equalize the pressure in the middle ear, thus improving patient comfort. Anyone who has had their ears “pop” in an airplane during descent is familiar with the sensation of middle ear pressure.

Ear tubes migrate out of the eardrum due to renewal of the tympanic membrane surface. It generally takes about 6 months for this to occur. The tubes eventually fall out of the ear canal without intervention. There is no indication for consultation, steroids, or antibiotics.

Here is the complete video exam. Note that the patient performs a Valsalva maneuver towards the end of the video. The movement of the eardrum indicates that the Eustachian tube is functioning and that the ear is now ventilating properly post-extrusion of the ear tube.