A 4-year-old female presents to her pediatric clinic for ear trauma follow-up. One week ago, the child inserted a thermometer into her right ear. The following image is obtained with the Wispr otoscope.
What is the best course of action?
The child has trauma to her tympanic membrane, likely a perforation. Otolaryngology (ENT) should be consulted. A good starting point for the consultation is sharing this image with them.
The image suggests that there has been trauma to the tympanic membrane (TM, ear drum) just anterior to the umbo of the malleus. A TM perforation is not clearly visible but the area of central darkness suggests congealed blood. In addition, there appears to be blood in the middle ear space, i.e. behind the TM (hemotympanum). The area of trauma to the TM is anterior-superior, likely sparing the ossicles of the middle ear space which are located posterior-superior.
TM perforations often heal on their own. Still, given the age of the child and the likely damage to the TM, an ENT consult on an urgent but not emergent basis is reasonable. The parents should be advised to avoid pool or lake water until an ENT consult is obtained. Antibiotics could be considered but are not generally indicated for a “clean” perforation.
WiscMed thanks Dr. Bradley Harris of Kids First Pediatrics in Scottsboro, AL for this week’s interesting case. Dr. Bradley reports that the Wispr otoscope was particularly helpful in this case as the child was uncooperative. Because of the Wispr’s video capability, there was no need for a nurse to hold the child down during the exam. Here is the complete video exam.