QuestionSBA
QuestionChoice
Cerumen (ear wax) in the ear canal is one of the most common causes of conductive hearing loss. It would not lead to a change in the appearance of the tympanic membrane
32336
d
Cerumen impaction
QuestionChoice
A vestibular schwannoma (acoustic neuroma) is usually a slow-growing tumour of the cerebellopontine angle. It can present with sensorineural hearing loss, vertigo and tinnitus
32337
e
Vestibular schwannoma
QuestionChoice
Tympanosclerosis refers to calcification of the middle ear and tympanic membrane. The aetiology is not fully understood, but the major risk factors are middle ear infections and grommet insertion. The condition is characterised by chalky white patches on the tympanic membrane and a conductive pattern of hearing loss
32333
a
Tympanosclerosis
QuestionChoice
Otosclerosis is a condition in which there is abnormal bone growth in the middle ear. It is a cause of conductive hearing loss but would not explain the characteristic appearances of the tympanic membrane described
32335
c
Otosclerosis
QuestionChoice
Chronic otitis media presents with ear discharge for greater than six weeks. Often there will also be perforation of the tympanic membrane on examination
32334
b
Chronic otitis media
QuestionComment
Probably important to note here that negative Rinne's = BC>AC (referring to a true negative Rinne's) as I've only really seen it written out in full
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# Summary

Tympanosclerosis is a condition characterised by chronic inflammation and scarring of the tympanic membrane, leading to its subsequent calcification. Patients typically present with significant hearing loss and chalky-white patches on the tympanic membrane. Key investigations include an otoscopic examination and audiometric testing. Management strategies include the use of hearing aids and, in refractory cases, surgical excision of the sclerotic areas and repair of the ossicular chain.

# Definition

Tympanosclerosis is a chronic disease that involves inflammation, fibrosis, and calcification of the tympanic membrane and other structures within the middle ear.

# Epidemiology

The epidemiology of tympanosclerosis is not well understood due to the paucity of data. However, it is known to be associated with certain risk factors such as a history of chronic otitis media and tympanostomy tube insertion.

# Aetiology

The exact cause of tympanosclerosis remains unclear, but it is believed to be associated with chronic otitis media and the insertion of tympanostomy tubes, also known as grommets. Other potential contributing factors may include trauma, ototoxic drugs, and genetic predisposition.

# Signs and Symptoms

The primary symptom of tympanosclerosis is significant hearing loss. Upon physical examination, the tympanic membrane will often display chalky white patches due to the calcification process.

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# Differential Diagnosis

The differential diagnosis for tympanosclerosis includes:
- Chronic otitis media: Characterised by recurrent ear infections, persistent ear discharge, fullness or pressure in the ear, and hearing loss.
- Otosclerosis: Presents with progressive conductive hearing loss, tinnitus, and occasionally vertigo.
- Cholesteatoma: Symptoms include hearing loss, ear discharge, and a sensation of fullness or pressure in the ear.

# Investigations

The diagnosis of tympanosclerosis typically involves a comprehensive otoscopic examination and audiometric testing to assess the degree of hearing impairment.

# Management

Management of tympanosclerosis primarily involves addressing the hearing loss. Common strategies include:
- The use of hearing aids to improve auditory function.
- In cases that are refractory to hearing aids, surgical intervention may be considered. This involves the excision of the sclerotic areas and repair of the ossicular chain.
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Picture
An example of tympanosclerosis seen on otoscopy.
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Tympanosclerosis
Topic
24
Ear, Nose & Throat
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Tympanosclerosis is characterised by chalky white patches on the tympanic membrane and can lead to conductive hearing loss.
A 40-year-old man with a history of recurrent right-sided otitis media presents with a one-month history of gradually worsening hearing loss in his right ear. He denies any other symptoms, and his past medical history is otherwise unremarkable.

On examination, otoscopy reveals chalky white patches on the tympanic membrane. Rinne's test is negative on the right, and Weber's test lateralises to the right ear.

Which of the following is the most likely diagnosis?
a