Ophthalmology sims scenarios

Question 1

A 14 year old boy presents with this problem . Hearing has been an issue on the right side for a few months. He feels it started with a cold. Although the left ear was also initially affected this has since improved. Comment on the otoscope findings

Answer 1

Otitis media with effusion
- though the TM bubbles can be seen in the residual fluid in the middle ear as the ET has started to function again and it getting to the middle ear as the mucus is being transported out to the nasopharynx.
- there are 2 patches of tympanosclerosis in the TM - these are the 2 white patches, an anterior patch and a larger posterior patch

Question 2

A 4 year old boy is bought to the clinic by his parents. His speech and language are delayed. His parents are unsure if his hearing is affected. He has had several courses of antibiotics in the past 3 years for ear infections.

Answer 2

Otitis media with effusion (glue ear)
- presence of sterile fluid in the middle ear that’s been present for 3 months
- the membrane is grey, dull and retracted with the malleus handle looking short because of the retraction
- there are radial blood vessels within the membrane
- there is no active infection

Question 3

This patient is now 54. Although she had some issues with ear infections as a child, she hasn’t reported issues for many years. A hearing test has recorded an elevated hearing threshold so she seeks your opinion.

Answer 3

• attic cholesteatoma
  -failure of migration has occurred from this attic retraction pocket
• the dead skin has formed a brown crust with more bone erosion
• beneath this is a cholestetoma
• she requires audiometery, CT scan and a plan for mastoid exploration

Question 4

This 20 year old female reports pain and then discharge from the ear. Hearing has not recovered

Answer 4

• posterior perforation of the TM
• small granulation on scarred rim of perforation
• patches of tympanosclerosis in the rest of the drum and middle ear mucosa, visible through the perforation is healthy.
• keep ear dry, the whole will close itself but follow up in 2 months
• tymlanoplasty if required should be discussed