Middle Ear, Tympanic Membrane, Infections Clinical Presentation

  • Author: John Schweinfurth, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 12, 2012
 

History

Generally, the patient presents with a 2- to 3-day history of ear congestion and mild hearing loss. Patients often have a history of self-cleaning of the EAC, trauma, or penetration of water into the EAC. Sensations of heaviness and slight pain in the ear are common. Sometimes an itch is present in the EAC, or discharge from it is noted.

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Physical

The TM has long been recognized as the true mirror of the middle ear, with all its changes reflected on the surface of the TM. In the case of AOM, examining the changes related to all stages of inflammation on the surface of the TM is possible. Otoscopy allows examination of the tensed grey-blue membrane with reflected light directed into the lower front section. The TM has identifiable items, such as the light reflect, the umbo, the handle of the malleus, the lateral process of the malleus, the lenticular process of the incus, and the anterior and posterior plicae of the TM.

Typical otoscopic examination results are as follows:

  • In cases of acute myringitis, the TM is evidently altered by the inflammatory process; it is red and deformed, and the light reflex is shortened or disappears completely.
  • Acute hemorrhagic myringitis can be the consequence of a bacterial infection such as S pneumoniae or a viral infection. Differential diagnoses for a red tympanic membrane are widely varied and include malformations, traumas, infections, and even tumors and other degenerative pathologies.
  • Acute bullous myringitis can also be the consequence of a bacterial or viral infection.
  • Myringitis granulosa, when the TM is covered with granulation tissue, may be observed.
  • When acute otitis has resolved, recognizing perforations of the TM is possible. These perforations are characterized by scarring (myringosclerosis) and areas of calcification.
  • In cases of chronic myringitis, the TM is perforated, with inflamed edges and granulation tissue.
  • Hearing loss may be noted.
  • Discharge from the EAC is present in some cases.
  • Some children experience pain upon traction of the pinna.
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Causes

Determining the cause of the TM inflammation is important to treat both it and the accompanying and subsequent processes of otitis media and external otitis. Causes include the following:

  • Bacterial infection
    • Staphylococcus pyogenes and Staphylococcus aureus
    • Escherichia coli and Klebsiella species
    • S aureus and Streptococcus epidermidis
    • Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis (causes of about 70% of cases)
    • Bacillus fragilis and Peptostreptococcus species
    • Pseudomonas aeruginosa, Proteus mirabilis, and S aureus
    • Mycoplasma pneumoniae (bullous myringitis)
    • Trichophyton rubrum in the external auditory meatus
    • Mycobacterium tuberculosis
  • Fungal infection
  • Viral infection (eg, herpes zoster, influenza)
  • Eczematous otitis externa, which can cause eczematous myringitis
  • Granulation tissue covering the TM
  • Extra-esophageal reflux[1]
  • Chronic myringitis, which is often accompanied by chronic inflammation of the middle ear or the EAC (Chronic myringitis is often mistaken for chronic otitis media. Such confusion prolongs the initiation of appropriate management and sometimes leads to needless tympanomastoid surgery. The ENT specialist should be aware of this clinical entity and its varied presentation.)
  • Chronic inflammation of the TM with perforation, which may also occur as a result of a condition developing at the junction between the skin and the mucous membrane (Retraction of the TM is clinically important because failure to do so is a possible cause of atelectasis, ossicular erosion, and cholesteatoma.)
  • For more information, see Otitis Media, External Ear, Infections, External Ear, Malignant External Otitis, and External Ear, Inflammatory Diseases.
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Contributor Information and Disclosures
Author

John Schweinfurth, MD  Professor, Department of Otolaryngology, University of Mississippi Medical Center

John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Laryngological Association, American Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Yuri P Uliyanov, MD, PhD  Director, Department of Ear, Nose, and Throat, Agami Medical Center

Yuri P Uliyanov, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Hoffer, MD  Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego

Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: American biloogical group Royalty Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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Tympanic membrane (TM) as continuation of the upper wall of external auditory canal (EAC) with angle of incline up to 45 degrees on the border between middle ear and the EAC.
Normal tympanic membrane. Pars tensa (PT), pars flaccida (PF), light reflex (LR), fibrous ring (FR), umbo (Um), handle of malleus (HM), lateral process of malleus (Lpm), anterior plica (AP), posterior plica (PP).
Mirror display of a tympanic membrane surface on the polymeric masc from external acoustical canal of healthy man. Masc of tympanic membrane surface (MtmS).
 
 
 
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