On pure tone audiometry, a patient shows an air-bone gap of 40 dB at all frequencies tested. Tympanometry shows a Type B flat curve with a low compliance peak. Stapedial reflexes are absent. What is the most likely finding on otoscopy?
- A Central perforation with mucopurulent discharge
- B Normal tympanic membrane with amber discolouration and a fluid level ✓
- C Retracted tympanic membrane with a granular surface
- D Blue drum with pulsatile movement
Correct answer: B. Normal tympanic membrane with amber discolouration and a fluid level
Explanation
A flat Type B tympanogram with low compliance and absent stapedial reflexes in a patient with a significant air-bone gap indicates fluid in the middle ear (otitis media with effusion). The tympanic membrane typically appears dull, retracted or bulging, amber or yellowish, sometimes with visible fluid levels or air bubbles. This pattern is pathognomonic for glue ear. The air-bone gap is conductive due to the dampening effect of middle ear fluid on tympanic membrane and ossicular vibration.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.