At an otoscopy workshop, a participant presented to the WiscMed station with concern for ear discomfort after a previous ear exam. The Wispr exam of her right ear is shown. What is the source of the participants ear discomfort and what is the next step in management?
The patient has both an old, healed injury to her tympanic membrane (TM) and a new abrasion to her external ear canal (EAC). No further management is necessary.
This is an interesting case because the participant in the workshop has both a healed injury and an acute injury.
The healed injury is to the tympanic membrane, likely from a prior ventilation tube. This healed injury has two features. First is the thinning of the tympanic membrane in the anterior inferior quadrant. This is likely where the ventilation tube had been placed. The thinning is likely due to incomplete healing of a layer of the TM. Second is the sclerosis which is seen as a white patch. Sclerosis is often associated with ventilation tubes or with recurrent acute otitis media (AOM).
Old, Healed Injury
The acute injury is to the external ear canal (EAC). The participant has an area of abrasion to the external ear canal that is causing scant bleeding. The bleeding originates from the EAC and can be seen to flow down the malleus to the central portion of the tympanic membrane. This injury was likely caused by a prior otoscopy exam where the speculum encountered the EAC. This illustrates a key advantage of the Wispr otoscope. The Wispr uses a patented speculum with a unique, small, geometry that makes contact with the EAC less likely, thereby potentially reducing ear trauma.