How would the normal tympanic membrane appear during an otoscopic examination
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Overview Show OverviewPneumatic otoscopy is an examination that allows determination of the mobility of a patient’s tympanic membrane (TM) in response to pressure changes. The normal tympanic membrane moves in response to pressure. Immobility may be due to fluid in the middle ear, a perforation, or tympanosclerosis, among other reasons. [1] The detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis of otitis media with effusion (OME). [2] The predictive value of visible eardrum characteristics for OME ranges widely. [3] Therefore, pneumatic otoscopy is important, as it can indicate the presence of effusion even when the appearance of the eardrum otherwise gives no indication of middle ear pathology. Pneumatic otoscopy has been found to have a high sensitivity and specificity for diagnosing middle ear effusion. [4, 5, 6, 7] It has also been shown to do as well as or better than tympanometry and acoustic reflectometry, and it is especially useful in a setting in which tympanometry is not readily available. [8] Other advantages are that it is cheap and easy to perform with appropriate training. Relevant AnatomyThe primary functionality of the middle ear (tympanic cavity) is that of bony conduction of sound via transference of sound waves in the air collected by the auricle to the fluid of the inner ear. The middle ear inhabits the petrous portion of the temporal bone and is filled with air secondary to communication with the nasopharynx via the auditory (eustachian) tube. The tympanic membrane (TM) is an oval, thin, semi-transparent membrane that separates the external and middle ear (tympanic cavity). The TM is divided into 2 parts: the pars flaccida and the pars tensa. The manubrium of the malleus is firmly attached to the medial tympanic membrane; where the manubrium draws the TM medially, a concavity is formed. The apex of this concavity is called the umbo. The area of the TM superior to the umbo is termed the pars flaccida; the remainder of the TM is the pars tensa. For more information about the relevant anatomy, see Ear Anatomy. IndicationsThe diagnostic evaluation of suspected otitis media with effusion (OME) should include pneumatic otoscopy. [2, 9, 10, 8, 11] Pneumatic otoscopy should be performed to assess for OME in a child with otalgia, hearing loss, or both. [11] Pneumatic otoscopy is a quick, painless test that takes a few minutes to complete. OME is a very common problem in early childhood and is responsible for substantial morbidity. [12, 13, 14, 15] Most children have at least 1 episode during their childhood; many have repeated episodes. [13, 14, 15, 16, 17] OME frequently is associated with conductive hearing loss, which is usually transient; however, it has also been associated with delayed speech and language development. [18, 19, 20] The history and physical examination may raise suspicion for OME, but diagnosis is confirmed by establishing the presence of a middle ear effusion. Siegle first described the principles and use of pneumatic otoscopy for detecting effusion more than a century ago. This was popularized by Politzer in 1909. [21] ContraindicationsApart from the technical difficulty of obtaining an adequate seal, no contraindications exist for pneumatic otoscopy. Great care and small pressure changes should be employed in patients with a very thin tympanic membrane or segment to avoid discomfort or perforation. AnesthesiaNo anesthesia is necessary in routine pneumatic otoscopy, and its use is discouraged. EquipmentSee the list below:
PositioningSee the list below:
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Author Catherine E Rennie, MBBS, MRCS Research Fellow, Department of Otolaryngology, St Mary's Hospital, London, UK Catherine E Rennie, MBBS, MRCS is a member of the following medical societies: Royal College of Surgeons of England, British Association of Otorhinolaryngologists, Head and Neck Surgeons Disclosure: Nothing to disclose. Coauthor(s) Frederik Carel van Wyk, MB, ChB, MRCS, FRCS(Edin) ENT Consultant Surgeon Frederik Carel van Wyk, MB, ChB, MRCS, FRCS(Edin) is a member of the following medical societies: British Association of Otorhinolaryngologists, Head and Neck Surgeons, British Rhinological Society, European Academy of Facial Plastic Surgery, Royal College of Surgeons of Edinburgh, South African Society of Otorhinolaryngology Head and Neck Surgery Disclosure: Nothing to disclose. Michael S W Lee, MB, ChB, FRCS Consultant ENT and Head and Neck Surgeon, St George's Hospital, London; Honorary Senior Lecturer, St George's Hospital and Medical School, University of London Michael S W Lee, MB, ChB, FRCS is a member of the following medical societies: British Medical Association, Royal Society of Medicine, British Association of Otorhinolaryngologists, Head and Neck Surgeons, Otorhinolaryngological Research Society Disclosure: Nothing to disclose. Abbad G Toma, MB, BCh, FRCSE, FRCS(ORL) Consultant Otorhinolaryngologist and ENT Surgeon, St George’s Hospital, UK Abbad G Toma, MB, BCh, FRCSE, FRCS(ORL) is a member of the following medical societies: British Association of Otorhinolaryngologists, Head and Neck Surgeons, British Medical Association, Royal Society of Medicine Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Chief Editor Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society Disclosure: Serve(d) as a director, officer, partner,
employee, advisor, consultant or trustee for: Cerescan, Ryte, Neosoma, MI10 Acknowledgements The authors would like to thank the staff in the ENT Clinic, St. Helier Hospital, London for their help in obtaining the images. Medscape Reference also thanks Hamid R Djalilian, MD, Associate Professor of Otolaryngology, Director of Neurotology and Skull Base Surgery, University of California Irvine Medical Center, for assistance with the video contribution to this article.
What is a normal tympanic membrane appearance?1) Color/shape-pearly grey, shiny, translucent, with no bulging or retraction.
How do you describe the tympanic membrane?The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear. When sound waves reach the tympanic membrane they cause it to vibrate. The vibrations are then transferred to the tiny bones in the middle ear.
What is the normal appearance of the tympanic membrane quizlet?The tympanic membrane is a translucent membrane with a pearly gray color and a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles.
How do you describe Otoscopic findings?Typical findings on otoscopy include a bulging red, yellow or cloudy tympanic membrane with an associated air-fluid level behind the membrane. There may also be discharge in the auditory canal if the tympanic membrane has perforated.
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