Common Conditions The following images relate to the numbered endoscope photographs used with the Adam Rouilly

y equipment. You may view any picture and the accompanying text by clicking the image. Figure 1 - The normal tympanic membrane Figure 2 - Wax Figure 3 - Acute otitis media with effusion (A) Figure 4 - Acute otitis media with effusion (B) Figure 5 - Acute otitis media with no recognisable landmarks Figure 6 - Serous (secretory) otitis media (A) Figure 7 - Fluid behind the eardrum Figure 8 - Resolution of middle ear infection Figure 9 - Serous otitis media (B) Figure 10 - Tympanosclerosis Figure 11 - Central perforation of the ear drum Figure 12 - Grommet - Tympanostomy tube

1. The

normal tympanic membrane

The normal tympanic membrane The normal tympanic membrane is thin and semi-transparent. When viewed through an otoscope it has a pearly-grey appearance and often some structures within the middle ear, such as the long process of the incus and the opening of the eustachian tube, can be seen if it is sufficiently transparent. Where the outer margin of the drum is attached to the external canal it is thickened and called the annulus fibrosa. The upper fifth of the drum is slack and called the pars flaccida and the lower four-fifths called the pars tensa. The handle of the malleus, which extends downwards and backwards, is a reliable landmark. The short process of the malleus protrudes forwards into the external canal. The umbo is the central attachment of the tympanic membrane to the malleus. From the umbo a cone of light extends downwards and forwards. The blood supply of the tympanic membrane comes form the ear canal superiorly. Prominent blood vessels on the rim superiorly are within normal limits.

2. Wax
Wax, or cerumen, is a normal secretion in the cerumenous glands in the outer part of the meatus, and can obscure or partially obscure the drum. When it is first produced it is colourless and semi-liquid in consistency, but with time it changes from pale yellow, to golden yellow, to light brown and finally black. As the wax darkens it also hardens, and the darker the colour the denser the consistency.

3. Acute otitis media with effusion (A)

Acute otitis media with effusion. There is distortion of the drum, prominent blood vessels in the upper half, with dullness of the lower half. There is also bulging of the upper half of the drum and the outline of the malleus is obscured.

4. Acute middle ear infection with effusion (B)

Acute middle ear infection with effusion. The handle of the malleus is obscured, and fluid levels are obvious behind the drum.

5. Acute otitis media with no recognisable landmarks

Acute otitis media with no recognisable landmarks. There is considerable bulging of the ear drum with purulent fluid behind a tense tympanic membrane which sometimes heralds perforation. In some cases incision of the drum is require

6. Serous (secretory) otitis media (A)

Appearance of serous (secretory) otitis media. The ear drum has lost its lustre and an effusion is visible through the ear drum with a fluid meniscus defining the upper margin.

7. Fluid behind the ear drum

Fluid behind the ear drum in an asymptomatic child. Effusion is visible with a fluid level in the lower half of the ear drum. The handle of the malleus is also difficult to visualise.

8. Resolution of middle ear effusion

Resolution of middle ear effusion. The handle of the malleus is still foreshortened and the horizontal. Signs in the upper half of the ear drum suggest that fluid is still present in the middle ear.

9. Serous otitis media (B)

Serous otitis media. There is indrawing of a dull ear drum and the handle of the malleus is characteristically horizontal. Eustachian tube obstruction had led to failure of replacement of air which is normally absorbed from the middle ear resulting in vacuum formation and effusion of fluid.

10. Tympanosclerosis
Tympanosclerosis. In some cases of otitis media healing may not be completed and the inflammatory process leads to the formation of scar tissue. This can take the form of calcified plaques on the tympanic membrane.

11. Central perforation of the ear drum

Central perforation of the ear drum. Perforations are usually single but may be multiple. Spontaneous rupture of the drum can occur in association with acute infection when the tense drum perforates and releases pus. The ear drum illustrated has a long standing perforation accompanied by tympanosclerosis of the drum.

12. Grommet tympanostomy tube

Grommet tympanostomy tube. Grommets can be inserted in the tympanic membrane if medical treatment and myringotomy are unsuccessful and the child has persistent middle ear effusion. The illustration is a silicone tube retained in an opening in the drum by inner and outer flanges.

Normal Ear and Hearing

Sound waves hit the eardrum. Vibrations of the eardrum pass on to tiny bones (the ossicles) in the middle ear - the malleus, incus and stapes. These bones transmit the vibrations to the cochlea in the inner ear. Sound signals are sent from the cochlea to the ear nerve and to the brain. The middle ear space behind the eardrum is normally filled with air. This air space connects to the back of the nose by the Eustachian tube.