Middle Ear Effusion Case File

https://medical-phd.blogspot.com/2021/03/middle-ear-effusion-case-file.html
Eugene C. Toy, MD, Lawrence M. Ross, MD, PhD, Han Zhang, MD, Cristo Papasakelariou, MD,
FACOG

CASE 47
A 12-year-old boy complains of a 2-week history of impaired hearing with his left ear. He states
that music and voices seem “far away.” His medical problems include allergic rhinitis and asthma.
On examination, he is afebrile, but his left eardrum displays a yellowish discoloration. The left
drum moves very little with a puff of air. The right tympanic membrane appears normal.

⯈ What is the most likely diagnosis?

⯈ What is the clinical anatomy for this condition?

ANSWER TO CASE 47:

Middle Ear Effusion
Summary: A 12-year-old boy with allergic rhinitis and asthma has a 2-week history of difficulty
hearing with his left ear. He is afebrile but has yellowish discoloration of his left tympanic
membrane, which does not move well with insufflation.

• Most likely diagnosis: Middle ear effusion

• Clinical anatomy of the condition: Middle ear fluid impeding sound transmission by the middle
ear ossicles

CLINICAL CORRELATION
Sound waves collected by the auricle and external acoustic meatus (canal) produce vibration of the
tympanic membrane. These vibrations are transferred, in turn, to the ear ossicles, the malleus, the
incus, and the stapes. Vibrations of the stapes produce movements of the endolymph within the
cochlea, which are converted to the nervous impulse responsible for the sensation of hearing. Fluid
within the middle ear cavity (effusion) diminishes the vibrations of the tympanic membrane and the
ear ossicles. Effusions develop in the middle ear secondary to obstruction of the pharyngotympanic
(auditory) tube, as with upper respiratory infections or allergic reactions. The insufflation of air
through the otoscope in this patient does not induce the normal fluttering of the eardrum, further
suggesting an effusion. An infectious process is unlikely in this case because of the absence of a
fever or a red eardrum. Treatment of effusions includes antihistamines, decongestants, and, in
severe cases, surgical incision of the tympanic membrane for drainage (myringotomy) and insertion
of drainage tubes.

APPROACH TO:
The Ear

OBJECTIVES
1. Be able to describe the anatomy of the external acoustic meatus (canal)
2. Be able to describe the anatomy of the tympanic membrane and the three ear ossicles
3. Be able to identify the structures of the middle ear cavity and those that communicate with it

DEFINITIONS
INSUFFLATION: Act of blowing a powder or gas into a body cavity, in this case through the
otoscope, to assess whether there is fluid in the middle ear.

PERILYMPH/ENDOLYMPH: The bony labyrinth of the inner ear contains the membranous

labyrinth. Within the lumen of the membranous ducts is endolymph, a fluid similar in composition
to intracellular fluid (low sodium, high potassium). The space between the ducts and the bony walls
is filled with perilymph, a fluid similar in composition to normal extracellular fluid (high sodium,
low potassium). The compartments that are filled with perilymph and endolymph do not
communicate.

EFFUSION: Spread of a liquid into a space. In this case, the fluid is from the inflammatory
response to the allergy.

MYRINGOTOMY: Procedure in which the tympanic membrane is pierced and tubes are inserted
into the opening to drain the exudate.