This is the otoscopic view of the left ear of a 35yr-old man presenting with chronic ear muco-purulent discharge for the past 10yrs.
Q1: Describe the abnormalities seen.
Q2: What is the name of this condition?
Q3: Name three theories in the causation of this disease (pathogenesis).
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13 comments:
A1: This is an otoscopic photo of the patient's left ear. There is a perforation at the anteroinferior quadrant of the tympanic membrane. The edges are smooth. The tympanic membrane is hazy/pearly white and the bony prominences cannot be appreciated. There appears to be multiple recessions (retraction pockets?) at the anterosuperior part of the tympanic membrane. Yellowish discharge seen in the middle ear cavity.
A2: Chronic suppurative otitis media with cholesteatoma
A3: Proposed theories-
a) invagination of the tympanic membrane
b) basal cell proliferation
c) epithelial in-growth through a perforation
d) squamous metaplasia of middle ear epithelium
Q1:
The otoscopy revealed:
1)a pale tympanic membrane without cone of light
2)A 25% perforation is seen at the anterior inferior region of tympanic membrane. The annulus involment will then determined whether it's a central or marginal perforation. However, marginal perforation is more likely in this case.
3)There is a retraction pocket seen at the attic region, probably a cholesteatoma lying bedind it.
4) Lose of handmarks like malleus on this tympanic membrane
5)Pus is seens on middle ear mucosa layer
Q2:
Chronic otitis media with cholesteatoma.
Q3:
Retraction pocket theory
Metaplasia of middle ear mucosa
Cholesterol cyst theory
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