Pulsatile Tympanic Membrane Perforation with Effusion

A previously healthy 9-year-old male presents to the pediatric clinic with two days of left ear pain and ear drainage. The child reports intermittent and improving drainage. On review of systems, the child has had no cough, no congestion, and no fevers. Physical exam was unremarkable except for a pulsating finding in the left ear. The child has a pulsatile tympanic membrane perforation with effusion.

The tympanic membrane (TM, ear drum) is clear not normal. There are changes to the TM that are consistent with the medical history of ventilation tubes including myringosclerosis. The malleus ossicle, while discernable, is not clearly defined. Most dramatic, is the small defect in the TM with an unusual pulsation.

The patient was referred to ENT who was only able to see profuse otorrhea and treated the child for otitis externa. However, ENT was able to review this video obtained from the primary care pediatrician. The differential diagnosis included vascular tumor vs middle ear effusion communicating vascular pulsation. Looking at the pulsation on the video, the rate of pulsation (about 96 pulses/minute) appears consistent with the heart rate of a 9-year-old patient. This case illustrates the dual benefits of the Wispr. First, the ability to record video, and second, the ability to share that record with specialists.