CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
30-year-old with no Hearing Complaints
A healthy 30-year-old woman with no hearing complaints presents for a yearly physical examination. She has no history of ear infections or tympanostomy tubes. She feels well without congestion, fever, or ear pain. The following image of her tympanic membrane was obtained with the Wispr digital otoscope.
What is the next step in management?
A. Initiate antibiotics for acute otitis media (AOM)
B. Repeat ear exam in one month.
C. Non-urgent referral to otolaryngology (ENT)
D. Recommend avoiding cold water activities
Answer: C. Non-urgent referral to otolaryngology (ENT)
The tympanic membrane (TM, eardrum) is not normal. There is bulging along with loss of bony landmarks. The criteria for diagnosing acute otitis media (AOM) according to the American Academy of Pediatrics (AAP) guidelines include moderate to severe TM bulging or mild TM bulging with ear pain and intense erythema. In this case, the patient appears to have moderate to severe bulging, but it does not appear to be from middle-ear pressure. This is because although bulging is evident, it does not appear like an angry donut, and the characteristic central umbo dimple is missing. This suggests some type of chronic TM condition as opposed to AOM. Further, the patient has no hearing complaints or symptoms to suggest infection. Antibiotics are not indicated. A repeat ear exam in one month could be a reasonable approach, but better is to send an image of the findings to ENT as a virtual consult to see if they would like to see the patient non-urgently. There is no indication to avoid cold water activities. Cold water activities are associated with exostosis, which is not present here.
Here is the complete video of the exam.
