Near-total tympanic membrane perforation.

A 26-year-old man came to the office complaining of hearing loss in the right ear of several years' duration. He had a long-term history of recurrent ear infections in both ears since childhood. He reported that his right ear had been dry over the past few months but that he had previously experienced intermittent drainage. More recently, he said he had been careful to protect the ear from water.

Examination under the microscope detected a near-total perforation of the right tympanic membrane (figure). Tympanosclerosis was seen in an anterior remnant of the drum. The middle ear mucosa was normal. The ossicular chain, the incudostapedial joint, and the stapedial tendon were intact and well visualized. Mucosal adhesion was seen between the long process of the incus and the malleus handle. The Shrapnell membrane was intact, and the chorda tympani was in its normal position. The facial nerve could be seen over the footplate and oval window areas. No cholesteatoma formation was evident.

The Weber test lateralized to the right ear, and the bone conduction was greater than the air conduction. Audiometry detected a 40-dB conductive hearing loss on the right.

The patient underwent a successful overlay tympanoplasty, and his resultant hearing was good.

From the House Ear Clinic and the Keck School of Medicine, University of Southern California, Los Angeles.

Jose N. Fayad, MD; John W. House, MD