Scarred tympanic membrane.

A 50-year-old woman was referred to us by her family physician because he had seen "a hole in her eardrum." The patient's history included many ear infections with episodes of drainage during childhood, but none since then.

On examination of the left ear, we observed a scarred tympanic membrane with a thin neomembrane posterior to the malleus (figure). The malleus appeared to be normal, but the incus was not visible. The right ear also showed signs of the patient's previous infections. The 512-Hz tuning fork test lateralized to the left ear, and air conduction was better than bone conduction in both ears. Her audiogram revealed an air conduction pure tone average of 25 dB and a bone conduction average 15 dB. The patient did not complain of hearing problems.

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This case is an example of a severely scarred tympanic membrane in an asymptomatic patient. The scarring occurred as a result of the patient's childhood infections. Her hearing was low-normal, and she had a minimal air-bone gap. No further treatment was indicated. The patient and the referring physician were reassured that she did not have "a hole in her eardrum" and that her condition would not progress.

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