A sixty eight year old male patient presented with a chief complaint of progressive hearing loss noted over the last three years. The referring PCP noted a "growth" on the left tympanic membrane. Pure tone audiometry revealed a mild, sloping mixed loss of hearing with a 10-15 dB air-bone gap.
Tympanometry revealed a Type Ad tympanogram with middle ear pressure at +95 daPa. Acoustic reflexes were absent. The patient reportedly blew his nose within the preceding 30 minutes.
Video otoscopy, Figures A and B, revealed a ballooning central monomeric scar ringed with peripheral monomeric bulges. With medical clearance, this ear will be fitted with a vented (CLASS II) CIC hearing instrument with canal tip calibrated in length to avoid contact with the TM balloon scar.
