Ear discharge and hearing loss in an elderly woman
A 78 year old woman was referred by her general practitioner to the outpatient ear, nose, and throat clinic with a three week history of a discharging right ear (otorrhoea). She had difficulty hearing in both ears and normally used a hearing aid in her “better,” right ear. On further questioning she denied experiencing any pain in her ear or tinnitus in either ear. She had no other relevant symptoms.
(1) What are the findings on otoscopy?
(2) What should you look for on otoscopy?
(3) What is the differential diagnosis of otorrhoea?
(4) How would you treat this patient and what advice could be given?
(1) The figure shows the otoscopic view of the right tympanic membrane. There is a large, infective, central perforation. Additionally, mucopurulent discharge is present and the surrounding skin appears erythematous and wet.
(2) To make an accurate assessment of the tympanic membrane clinicians need