Inflammatory cast of the tympanic membrane after acute otitis media

Objective: To describe a relatively unknown clinical entity – inflammatory cast of the tympanic membrane after acute otitis media – and its simple out-patient treatment. Study design: Retrospective review of case series. Setting: Subspecialty practice at a tertiary hospital. Patients: Seven patients diagnosed previously with acute otitis media with perforation or otitis externa, and with persistent ear discomfort. Methods: Retrospective chart review. Results: The patients presented with weeks to months of persistent hearing loss after acute otitis media with perforation or acute otitis externa. Visits to their primary care physicians had been uninformative. After comparison of the affected and unaffected tympanic membranes, a thin, hard cast was identified and removed from the affected tympanic membrane. Improvement in hearing was documented in the three patients who underwent audiometric testing; the remainder had subjective improvement without audiometric evaluation. Conclusion: Otolaryngologists should be aware of the possibility of an inflammatory cast of the tympanic membrane following acute otitis media with perforation or otitis externa, and should carefully compare the unaffected and affected ears in such cases. Treatment – removal of the rigid cast – is both simple and effective.