A 56-year-old employee of WiscMed was performing an examination on himself using the Wispr Digital Otoscope. An apparent “hole” in his eardrum caught his attention. He has no ear pain and no loss of hearing. He has never had ear trauma or a history of ear infections.
The WiscMed employee has retraction of the pars flaccida.
In this case, it presents as what appears to be a “hole” in the tympanic membrane. The hole is actually a retracted portion of the tympanic membrane that has a localized area of vasculature. The pars flaccida, as the name suggests, is the “looser” portion of the tympanic membrane that drapes across the superior portion of the malleus.
The tympanic membrane divides the external ear from the middle ear. The portion of the membrane that drapes across the malleus bone can become retracted for a number of reasons. One reason is a prior history of trauma or infections, the other is compressed geometry of the ear canal. In this case, the compressed geometry of the ear canal is causing a fold of the tympanic membrane that appears as a “hole.” This might be considered a pseudo retraction. Compare this case with another example of pars flaccida retraction and normal:
WiscMed thanks Dr. Michael Poole of Georgia Ear, Nose and Throat for his consult on this case and we highly recommend his book “Otitis Media” available currently at no charge on Apple Books.
Here is the complete video exam:
Complete exam video