From the Guidelines
The physical examination of the ears reveals asymmetric findings, with the right tympanic membrane appearing dull and the left ear demonstrating clear fluid behind the tympanic membrane, consistent with a middle ear effusion, as defined by the presence of fluid in the middle ear without signs or symptoms of acute ear infection 1. The examination would typically include:
- Assessment of tympanic membrane landmarks (light reflex, pars tensa, pars flaccida)
- Mobility using pneumatic otoscopy, which is a method of examining the middle ear by using an otoscope with an attached rubber bulb to change the pressure in the ear canal and see how the eardrum reacts 1
- Evaluation for erythema, bulging, or retraction Associated findings might include:
- Decreased hearing on audiometric testing, particularly conductive hearing loss, which is hearing loss from abnormal or impaired sound transmission to the inner ear, often associated with effusion in the middle ear 1
- Tympanogram, an objective measure of how easily the tympanic membrane vibrates and at what pressure it does so most easily, which can help diagnose middle ear effusion 1 These findings often result from eustachian tube dysfunction leading to negative middle ear pressure and subsequent accumulation of sterile fluid, as seen in otitis media with effusion (OME), which may occur during an upper respiratory infection, spontaneously because of poor eustachian tube function, or as an inflammatory response following acute otitis media (AOM) 1. Management typically involves watchful waiting for 3 months in otherwise healthy patients, as many cases resolve spontaneously, but persistent effusions, especially with hearing loss or recurrent infections, may warrant consideration of tympanostomy tubes 1.
From the Research
Physical Exam for Ear Complaints
The patient presents with a dull right ear and clear fluid in the left ear. A physical exam for ear complaints typically includes:
- Otoscopy: to visualize the ear canal and eardrum, and to check for signs of infection or fluid buildup 2, 3
- Pneumatic otoscopy: to assess the mobility of the eardrum and detect any fluid in the middle ear 3
- Tympanometry: to measure the movement of the eardrum and the reflexes of the middle ear muscles, and to detect any fluid or infection in the middle ear 3
- Hearing test: to assess the patient's hearing and detect any hearing loss or impairment 3, 4
Diagnostic Considerations
The presence of clear fluid in the left ear may indicate otitis media with effusion (OME), a common condition in children characterized by the presence of fluid in the middle ear without signs or symptoms of acute ear infection 2, 3, 4. The dull right ear may be a sign of a different condition, such as acute otitis media (AOM), which is an infection of the middle ear 5.
Management and Treatment
The management and treatment of OME and other ear conditions typically involve watchful waiting, surgical procedures such as tympanostomy tube insertion, and adenoidectomy in some cases 2, 3, 4. The use of antihistamines, antibiotics, and steroids is not recommended for OME, as they have not been shown to be effective in treating the condition 3, 6.