An 82-year-old male seeks medical care for ear pain. Two days prior he reports left upper jaw pain that radiated to his left ear. The pain subsequently localized to his left ear. He describes the pain as a baseline throbbing with an occasional sharp component. He reports dental care about 2 weeks ago. No history of fevers, difficulty swallowing, difficulty breathing, facial swelling, or changes in hearing. The patient noticed increased ear discomfort during a recent airplane trip. He reports that sweets bother his teeth. On exam, he is a well-appearing male appearing younger than the stated age. He is chatting comfortably with no noted hearing problems. He walks with a steady gait. Axial loads of teeth 14 and 15 do not elicit any discomfort. No acute dental deficits are noted. Visualization of the left ear was heavily comprised by cerumen, however this image of the right ear was obtained.
This patient has Otitis Media.
Although visualization of the left ear in question was incomplete, there was evidence of loss of definition of the malleus at the pars flaccida. This could be associated with acute otitis media. The right ear was better visualized and has a donut appearance consistent with fluid collection in the middle ear space. There is no distinct erythema associated with the tympanic membrane suggesting that this may be a chronic condition.
This is a typical clinical scenario with associated diagnostic uncertainty. Given the history of recent dental cleaning along with the origin of the discomfort being at the upper left jaw with subsequent migration to the ear, it seems reasonable to conclude that a mild bacterial infection could be the cause of the patient’s symptoms. It is unclear if the finding of the right ear was chronic or acute. The patient reported poor baseline hearing from the right ear. The patient was allergic to primary antibiotics and so was placed on a course of a secondary antibiotic. During follow-up with the patient over the next two days, he reported complete resolution of symptoms.
Here is the video of the patient’s right ear exam: