Fibroadhesive otitis.

A 35-year-old woman sought evaluation for hearing loss. She had experienced frequent episodes of otitis as a child, but she had not discharged any otorrhea for several years.

Otoscopy identified what appeared to be a large posterior perforation that was actually a retraction pocket (figure). The tympanic membrane was atrophic and lined the medial wall of the middle ear. This thin epithelial layer adhered intimately to the promontory, to the round window, to the long process of the incus, and to the stapes and its tendon. The anterior tympanic remnant was thickened and had been infiltrated by a plaque of tympanosclerosis that extended from the malleus handle to the anterior annulus. The handle was immobile.

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Examination with a Siegle speculum and an unsuccessful politzerization pointed to a diagnosis of complete tubal obstruction. A hearing aid was recommended to correct the patient's 50-dB auditory impairment. From an inflammation standpoint, the ear was considered to be stable.

Christian Deguine, MD

Jack L. Pulec, MD ([dagger])

From Gap, France (Dr. Deguine), and the Pulec Ear Clinic, Los Angeles (Dr. Pulec).

([dagger]) The late Dr. Pulec was editor-in-chief of EAR NOSE & THROAT JOURNAL from 1992 through 2003.