A 65-year-old woman presents to the emergency department complaining of left leg weakness. She has had multiple falls today. She has been feeling “dizzy” and her left ear has been “popping.” Her son accompanies her and also says that her speech is not normal. She has a history of smoking for many years. This image of her left ear is obtained.
The patient has a perforation of the tympanic membrane in the anterior pars tensa.
The perforation looks chronic and is likely not related to her presentation tonight. The perforation extends to the anterior surface of the malleus. The eustachian tube orifice is seen through the defect in the tympanic membrane. Surprisingly, the patient does not complain of decreased hearing in this ear.