A 53-year-old male presents with new-onset unilateral hearing loss. On otoscopic exam, the tympanic membrane is dull and pneumatic otoscopy reveals hypomobility. This condition is commonly seen as a sequelae of which of the following conditions?
1.Hypertension
2.Hypercholesterolemia
3.Rheumatoid artheritis
4.Systemic lupus erythematosus
5.Human immunodeficiency virus
sol:
This patient is suffering from serous otitis media, which is seen in HIV with lymphadenopathy.
Serous otitis media is a condition which results from obstruction of the fluid outflow tracts (Eustacian tubes) and consequent buildup of fluid in the middle ear. Of note, the fluid is not infected. This can be caused by many conditions, including lymphomas or lymphadenopathy. On exam, the tympanic membrane is dull and hypomobile on pneumatic otoscopy (as a result of the fluid behind it).
Onusko details the role of tympanometry in assessing the presence of fluid in the middle ear and mobility of the middle ear system. This data can supplement more subjective visual inspection with otoscopy. Its use is vital in the diagnosis of otitis media with effusion and to a lesser extent in acute otitis media.
Keereweer reports that chronic serous otitis media is commonly related to dysfunction of the eustachian tube due to infectious rhinitis and occasionally to obstruction by nasopharyngeal tumors. In this case report, a patient with chronic serous otitis media was found to have bone destruction by a temporal meningioma.
Otoscopic view of serous otitis media. Note the bulging tympanic membrane but lack of purulence and inflammation.
