A 32-year-old woman comes to the office with ear pain. She has seasonal allergies for which she has been taking over-the-counter decongestants. Two days ago, the patient began having throbbing right ear pain that became intense yesterday. The pain is much better today, but she noticed a white discharge on her pillow when she awoke this morning.
Otoscopic examination shows a cloudy and red tympanic membrane with an area of perforation.
Which of the following is the most likely outcome of this patient's condition?

Question

A 32-year-old woman comes to the office with ear pain.  She has seasonal allergies for which she has been taking over-the-counter decongestants.  Two days ago, the patient began having throbbing right ear pain that became intense yesterday.  The pain is much better today, but she noticed a white discharge on her pillow when she awoke this morning.
Otoscopic examination shows a cloudy and red tympanic membrane with an area of perforation.
Which of the following is the most likely outcome of this patient's condition?

Quizplus · Accepted Answer

This patient's presentation is consistent with acute otitis media (AOM) complicated by perforation of the tympanic membrane (TM). Although it is more common in children, AOM can occur in adults and is most commonly due to Streptococcus pneumoniae and non-typable Haemophilus influenzae. AOM often presents several days after an upper respiratory infection or worsening seasonal allergy symptoms. Such patients usually have Eustachian tube dysfunction causing middle ear inflammation and fluid retention. Patients with AOM usually develop unilateral ear pain (otalgia), decreased hearing, and possibly fever. Physical examination typically shows an opaque and/or erythematous TM with bulging and poor mobility. Subsequent perforation of the TM then may lead to purulent otorrhea and relief of ear pain. Oral antibiotics (eg, amoxicillin) for AOM usually lead to symptom improvement and resolution of hearing loss. A ruptured TM typically heals completely with a combination of oral and topical antibiotics and prevention of water entry into the ear canal. (Choice B) Topical acetic acid can treat external otitis but is usually avoided in patients with a perforated TM as it can cause further damage. (Choice C) Acute mastoiditis is a possible complication of AOM, but it is more common in children and rare in adults (0.5% of cases). (Choice D) Short-term hearing loss can occur in AOM, but it typically improves with antibiotics and healing of the TM. Chronic OM is more commonly associated with long-term hearing loss. (Choice E) Reconstructive surgery is usually reserved for patients with AOM extending to the bone (eg, refractory mastoiditis). However, this is a rare complication in adults. Educational objective: Rupture of the tympanic membrane in adults with acute otitis media is characterized by purulent otorrhea and relief of the initial ear pain. It usually resolves completely with a combination of oral and topical antibiotics. __________ References: Acute otitis media in adults: many unknowns. (http://www.ncbi.nlm.nih.gov/pubmed/12825601)

A 32-Year-Old Woman Comes to the Office with Ear Pain