A five-year-old female is brought to the pediatric clinic by her mother with concern for ear pain. The child has a history of acute otitis media and had tympanostomy tubes placed about 6 months ago. For the past five days, the child has been complaining about right ear pain that seems to be getting worse. The mother has been using over-the-counter analgesics, but they have not been effective in the past day. This image of the right ear is obtained.
What is your diagnosis and what action should be taken?
The child has an extruded tympanostomy tube and acute otitis media. Antibiotics should be considered along with a referral to an ENT specialist.
The previously placed tympanostomy tube (ear tube, ventilation tube) has become extruded (fell out). This is an expected outcome of tube placement and generally occurs between 6 months and 1 year after placement. The eardrum generally heals quickly after the tube falls out although sclerosis may develop. The presence of bulging of the tympanic membrane (eardrum) indicates increased pressure in the middle ear space that is not being properly ventilated by the Eustachian tube. The bulging and pain likely represent acute otitis media (AOM). Considerations would include placing the child on antibiotics and referring to ENT for possible replacement of the tympanostomy tube.