Chronic Changes – April 6, 2023

Chronic Changes – April 6, 2023

A 60-year-old male presents to the clinic for a re-evaluation of his left ear. Two weeks ago, he was seen in the clinic and was diagnosed with a viral infection and a left ear infection. He completed a course of prescribed antibiotics. Both his viral symptoms and his ear pain have improved.

The Wispr otoscope exam of his left ear is shown here.

What is the next step in management?

The patient has chronic-appearing changes to his left ear. No further action is necessary.

The patient has what appears to be chronic changes to his left ear. The malleus is indistinct and there is evidence of   of the ear drum. Compare a normal ear, this image of chronic changes, and an ear with acute otitis media (AOM).

Although the malleus is indistinct in the chronic change image, it is present and discernable unlike in the case of AOM. In addition, there is no bulging of the ear drum as in the AOM example. The chronic tympanic membrane is clearly not as pristine as in the normal case. It’s easy to imagine that the ear drum with chronic changes has experienced multiple insults (infections, trauma) that have resulted in the scarred appearance.

Given the appearance of the ear in this week’s case, it calls into question if there was in fact an ear infection present two weeks ago. It’s possible that with a quick and incomplete glance using an analog otoscope that the chronic changes may have appeared acute. Here is an article on the natural history and resolution of an ear infection in images. Note that it takes many weeks for a case of AOM to completely resolve.

WiscMed has prepared a visual diagnosis guide to ear conditions that may be found here.

View a video of the complete ear exam: