35-year-old Woman with Ear Finding

A healthy 35-year-old woman received a demonstration of the Wispr digital otoscope at the 2026 American Academy of Pediatrics (AAP) show in San Diego. The following image of her ear was obtained.

What unusual finding is present in her exam?

A. She has a significant tympanic membrane retraction with a prominent incus.
B. She has evidence of a prior tympanic membrane rupture.
C. She has had a history of ear infections.
D. There are no unusual findings; this is a normal ear.

The patient has a prominent malleus and incus. The incus is more prominent than generally seen. The patient likely has a tympanic membrane retraction causing these features to be so notable. In addition, the patient’s pars flaccida is also retracted. Retraction is often associated with negative pressure in the middle ear space, causing the tympanic membrane to pull “inwards.” It can also be associated with chronic acute otitis media (AOM) or effusions. The patient does not have any clear evidence of AOM, such as sclerosis. It is clearly not a “normal ear” given the prominence of the ossicles. No action is necessary; a retraction does not generally affect hearing.