CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
31-year-old with Decreased Hearing
A 31-year-old woman with a history of decreased hearing had an ear tube placed in her right ear. Shortly after having the ear tube placed, the patient could still “pop” her ears, much like you do in an airplane during a descent. The following image was obtained when the patient was “popping” her ear.
What is the next course of action?
A. The tube is ventilating as expected.
B. Antibiotics should be initiated.
C. Urgent return to otolaryngology (ENT) for evaluation of tube patency and placement.
D. Steroids should be initiated.
A. The tube is ventilating as expected.
Although it is difficult to see from the still image, bubbles and fluid are coming from the ear (ventilation, tympanostomy) tube during the Valsalva (ear popping) maneuver. Refer to the video below to better appreciate the fluid and bubbles. Because fluid is coming out of the tube, the tube must be ventilating the middle ear space. Normally, an ear tube equalizes the pressure between the middle ear space and the outside world such that it is not possible to “pop” the ear. It’s likely that a build-up of viscous middle-ear fluid keeps the pressure in the middle ear space higher even in the presence of the ventilating tube, allowing the patient to “pop” her ears. The sensation of popping is due to a sudden equalization of pressure in the middle ear space with the outside world.
There is no evidence of infection, such as acute otitis media (AOM) and therefore no indication for antibiotics. Since the tube is functioning as expected, there is no reason to consult ENT. Steroids have no role in this situation.
Here is the complete video exam.
