A 27-year-old female with a history of metabolic syndrome and cholesteatomas presents to the emergency department with a complaint of chest pain. During the physical examination, she is noted to have a bone-anchored hearing aid (BAHA) posterior-superior to her right ear lobe. Further questioning elicits that she has a history of multiple ear surgeries and has significantly diminished hearing in each ear. This image is obtained of her left ear.
The patient has a cartilage lesion.
The patient has a lesion superior to her malleus. In addition, she has changes to the tympanic membrane including sclerosis. that support her history of ear surgeries. The patient relates that as a child she had cholesteatomas in each ear requiring surgery. Cholesteatomas are often the result of the eustachian tube dysfunction allowing for the accumulation of keratin in the middle ear space. This accumulation can damage both the eardrum and the chain of bones. When this occurs, surgery is required to repair the structures. The lesion seen in this image is most likely cartilage secondary to that repair.
Here is a video of the left ear:
The patient had similar changes to her right ear.
WiscMed thanks Dr. Michael Poole of Georgia Ear, Nose and Throat for consulting on this case and we highly recommend his book “Otitis Media” available currently at no charge on Apple Books.