Long-standing, near total tympanic membrane perforation.

A 76-year-old woman presented with a remote history of chronic otitis media with purulent otorrhea in her childhood. She had a long-standing hearing loss in her right ear and was seeking medical attention because age-related hearing loss had developed in her better hearing left ear. Clinical examination revealed a large, near-total tympanic perforation in her left ear (figure). Because of her age and underlying sensorineural hearing loss, she elected not to have surgical repair.

Chronic middle ear effusion can lead to ischemia and atrophy of the tympanic membrane. Further infections can then lead to spontaneous rupture. (1) Although most spontaneous perforations heal, repeated ruptures and chronic suppuration can lead to permanent perforations such as the one seen in this patient. These perforations frequently remain stable for years once the otitis-prone younger years are past.

Tympanoplasty, either transcanal or postaural, leads to closure in more than 90% of patients. (2) Hearing aid amplification is an option, but in some patients, it can contribute to retained moisture, infection, and drainage. Limiting wearing time or fitting with an open mold may obviate this problem.

J. Scott Greene, MD, FACS

From the Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pa.

References

(1.) Tos M. Upon the relationship between secretory otitis in childhood and chronic otitis and its sequelae in adults. J Laryngol Otol 1981;95(10):1011-22.

(2.) Sheehy JL, Glasscock ME 3rd. Tympanic membrane grafting with temporalis fascia. Arch Otolaryngol 1967;86(4):391-402.

Caption: Figure. This otoendoscopic photograph shows the near total tympanic perforation and mesotympahnic structures, including the round window niche, the pyramidal process with stapedial muscle tendon, the facial nerve, the cochleariform process, and ossicular chain. The pars flaccida and a small portion of the pars tensa with myringosclerosis are preserved.