A 16-year-old female is at her pediatric clinic for a routine appointment. She has no complaints. She has normal hearing and has never had ventilation tubes. The following image of her right ear is obtained. What abnormality do you notice? What intervention is indicated?
This is a benign condition, and no intervention is indicated.
The tympanic membrane (eardrum) is comprised of three layers of tissue. The (1) outer cutaneous layer, the (2) middle fibrous layer, and the (3) inner mucosal layer. In the case of this patient, it appears that there is a localized thickening of either the outer cutaneous or middle fibrous layers. The cause of this is not known, but it does not seem to involve either infection or trauma. It is likely of embryologic origin. Dr. Michael Poole has named this condition “fibrous disk” and is well-described in Chapter 5 of his book “Otitis: The Expert’s Diagnostic Guide.”