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Ear infection and discharge reduce after medication. What does ad type tympanogram indicates?

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ENT Specialist
Practicing since : 1991
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Hi sir..I have had ear infection and had ear discharge before 3 weeks... after cleaning and medication with drops the inflammation has reduced and ear discharge has stopped. However in the tympanogram test my ear shows Ad type. The doctor says I have no perforation but retraction near attic.. my question is whether it would be cholesteatoma possible.. without perforation is it possible that I have cholesteatoma...what is your remedy on a hyperflaccid tympanic membrane... will it heal automatically.. thanks you in advance
Posted Mon, 25 Mar 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. An Ad type Tympanogram indicates either a hyper-mobile ear drum or disruption of the ossicular chain (the three small ear bones).

2. Old healed perforation and thinning of the ear drums can also lead to a flaccid eardrum with an Ad type of curve on a Tympanogram. The eardrum may also become flaccid by over-stretching due to changes in middle ear pressure and due to inflammation as you have a history of ear infection and discharge.

3. Factors such as decreased hearing and middle ear pressures are also important. Is the Ad type graph with normal ear pressure? It will be of great help if you can upload the recording and also an endoscopic image of your eardrums.

4. Retraction of the eardrum takes place due to negative pressures in the middle ear usually following actually slow or stop a retraction by equalizing middle ear pressures.

5. A cholesteatoma will actively produce a typical smelly, intermittent, scanty ear discharge which can be seen as a flaky discharge on ear examination.

6. If the fundus of the retraction sac can be easily seen, the chances of cholesteatoma is minimal. A small self cleansing attic pouch may be observed and treated conservatively.

7. If there is a doubt, a special new MRI scanning technique may help. You may read about it at WWW.WWWW.WW
8. Hence if there is no hearing loss, middle ear pressures are normal and the attic retraction is small, no active treatment is required. A hyperflaccid tympanic membrane will not heal spontaneously, but will require an operative procedure to replace or reinforce the flaccid / thinned out parts and the retracted area. The ossicular chain may be inspected at the same time.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

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