Fluid behind the ear drum in asymptomatic child. Effusion is visible with a fluid level in the lower half of the eardrum. The handle of the malleus is also difficult to visualise.
Resolution of middle ear effusion. The handle of the malleus is still foreshortened and horizontal. Signs in the upper half of the eardrum suggest that fluid is still present in the middle ear.
A further example of 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.
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.
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.
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.
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