Middle Ear, Tympanic Membrane, Infections Workup

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

Laboratory Studies

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Imaging Studies

  • Otomicroscopy with microscope or otoendoscopy with imaging display
  • Pneumatic otoscopy - Provides information on the appearance and mobility of the TM and is the preferred method for diagnosis
  • High-resolution computed tomography (CT) scanning of the temporal bones
  • Magnetic resonance imaging (MRI) - Useful for the evaluation of intracranial complications from otitis, but, otherwise, this modality tends to overestimate middle ear inflammatory processes.
  • Acoustic otoscopy - A method to examine the TM, using concurrent otoscopy and tympanometry, and that is especially useful for children
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Other Tests

  • Pure tone and speech audiometry: This consists of an oscillator, or signal generator; an amplifier; and an attenuator, which controls and specifies the intensity of tones produced. The shape of the audiogram for an individual with hearing loss can provide the otologist or audiologist with important information for determining the nature and cause of the hearing defect. The audiogram configuration of air conduction hearing loss can be used as an additional test for diagnosis of myringitis.
  • Tympanometry: Tympanometry can provide evidence of fluid behind the eardrum, while multifrequency tympanometry has become an accepted objective method to determine the status of the middle ear, especially in regard to diagnosis of effusion.
  • Infrared emission detection tympanic thermometry
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Procedures

  • Gentle cleaning of the EAC
  • Irrigation of the EAC for removal of the debris (may be contraindicated if the status of the TM is unknown)
  • Tympanocentesis: A small puncture is made in the TM with a needle to permit entry into the middle ear. This procedure permits culture and identification of the offending agent in situations in which this information is vital.
  • Myringotomy: In cases of AOM, myringotomy and removal of fluid prevents bursting of the TM when it bulges. It contributes to faster relief of systems, and the resulting incision usually heals quickly.
  • Tympanostomy with insertion of a tube into the middle ear to allow drainage: This is the most frequently performed otolaryngologic procedure in the United States; however, permanent perforation is possible.
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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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