GetMeOuttaThisMess Posted February 4, 2017 Share Posted February 4, 2017 Had a patient yesterday with what again? SNOT & COUGH! While examing the patient I noted that the left TM had a silver color appearance to it, that it was bulging slightly outward, and that in the center was a perfectly round ring with what would have been best described as an internal color-matching smaller round circle that had the appearance of a tympanostomy tube but wasn't (pt. has never had tubes). The best way to quickly describe it is that it looked like a silver fish eye, with the center round ring being the iris and the "tympanostomy tube" appearance as being the pupil. I asked her about it and she said that it had not been brought up but when I looked at her previous visit for SNOT & COUGH I had noted the same appearance and had asked her to see ENT. A.D. appeared normal. Is this lady morphing into liquid metal like T3 or is there another explanation? Link to comment Share on other sites More sharing options...
jmj11 Posted February 4, 2017 Share Posted February 4, 2017 Is it a possible FB of some sort stuck to her TM? I was looking in the ear of an 8-year-old and saw this strange brown circle, filling the whole canal, with a black circle in the middle of the brown one. It was in front of the TM. I was puzzled and thought "what the hell?" Then a light bulb went off. I asked the kid, "Could there be a piece of a pencil in your ear?" His mother looked at me like I was nuts. Then the kid said, "Maybe." It was. The end of a pencil shoved back near his TM. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 4, 2017 Author Share Posted February 4, 2017 Good thought but the appearance is fully circumferential and is far enough into the EAC to support idea of it being the TM proper. Sounds like the ring inside a ring appearance is consistent with what I'm seeing. I just wish she'd get ENT to look at it, kind of like the respiratory distress pt. yesterday that was trying to save some bucks by coming to the clinic first, who between gasps for air said his insurance (same as mine) "wasn't the best in the world". Guess folks expect a premium to cover ALL costs. Link to comment Share on other sites More sharing options...
Guest Paula Posted February 4, 2017 Share Posted February 4, 2017 I had a patient who came in with ear pain. Left ear looked like there was a perforation with a dark, central black hole, and what looked like dried blood in front of it. He had hearing loss and it just happened suddenly. Sent to ENT because it was so funky looking. Turns out it was a piece of his hearing aid (I had no idea he had hearing aids, was a younger guy, 50 or so). Dang it, I missed the FB. I love taking those things out of peoples ears. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 5, 2017 Author Share Posted February 5, 2017 I had a patient who came in with ear pain. Left ear looked like there was a perforation with a dark, central black hole, and what looked like dried blood in front of it. He had hearing loss and it just happened suddenly. Sent to ENT because it was so funky looking. Turns out it was a piece of his hearing aid (I had no idea he had hearing aids, was a younger guy, 50 or so). Dang it, I missed the FB. I love taking those things out of peoples ears. Bless you Paula for your kindness. "...younger guy, 50 or so" Link to comment Share on other sites More sharing options...
sk732 Posted February 5, 2017 Share Posted February 5, 2017 My sick bay was blessed with a digital otoscope when I was doing diving med in the Navy that I could take pictures with and e-mail to ENT - we got some pretty funky perfs there, as well as really wacked out looking otitis externas from the lovely places the folks were diving in. If it wasn't for the bulging TM, I'd have said an atypical view of the ossicles or a retained FB of some sort. Could be weird reflection from the bulging cone of the TM. SK Link to comment Share on other sites More sharing options...
jwells78 Posted February 7, 2017 Share Posted February 7, 2017 FB vs old perf scar? She have problems with OM as a youth? Pulled a pink Barbie shoe out of a 13 y/o boy's ear once that had thrown me on first glance---- wasnt even his primary complaint. It's that, or she is a cybernetic organism sent back through time.... Link to comment Share on other sites More sharing options...
cbrsmurf Posted February 7, 2017 Share Posted February 7, 2017 It's sometimes tricky depending on the patient, but if you have a decent otoscope, you can usually get a good photo with your smartphone Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 8, 2017 Author Share Posted February 8, 2017 No camera allowed (employer thing). I'm not in the traditional medical practice setting. Link to comment Share on other sites More sharing options...
mackjacks Posted February 17, 2017 Share Posted February 17, 2017 I have seen some (edit: 2) fungal TMs with a silvery appearance. If the TM is intact, it shouldn't hurt to try an antifungal ear drop. Let us know if you figure it out! Link to comment Share on other sites More sharing options...
Guest JMPA Posted February 17, 2017 Share Posted February 17, 2017 r/o cholesteatma/ acoustic neuroma with atypical appearance. a complete neuro exam should always be performed with hearing complaints Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 17, 2017 Author Share Posted February 17, 2017 Not consistent with a cholesteatoma nor would it be involving the TM without displacement of the membrane over the time interval in which I had seen her. The TM is as silver as mercury. To be visualized through the TM it would have to be a very large neuroma and would be associated with other symptoms. She's got it documented that she should see ENT so the ball is in her court. Link to comment Share on other sites More sharing options...
Guest JMPA Posted February 17, 2017 Share Posted February 17, 2017 Not consistent with a cholesteatoma nor would it be involving the TM without displacement of the membrane over the time interval in which I had seen her. The TM is as silver as mercury. To be visualized through the TM it would have to be a very large neuroma and would be associated with other symptoms. She's got it documented that she should see ENT so the ball is in her court. that type of reasoning is why many a diagnosis is missed. hence the term "atypical" Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 17, 2017 Author Share Posted February 17, 2017 Must've been a heck of an atypical neuroma then considering all middle ear structures would require displacement to total obstruct the TM and not impact hearing acuity (screened with a tuning fork on initial visit). I'm comfortable in excluding a cholesteatoma. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 17, 2017 Author Share Posted February 17, 2017 Wondering if pt. used colloidal silver drops preventively since it's a "natural remedy" OTC option for ear infections? Addendum: color varies based on concentration but at high concentration is typically amber in color. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.