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An
audiogram showed mixed hearing loss in the left
ear: the hearing loss was purely conductive below
4000 Hz and mostly sensorineural above that
frequency. The right ear had purely sensorineural
hearing loss above 4000 Hz, paralleling the leftsided
loss (Fig. 1 in the Supplementary Appendix,
available with the full text of this article at
NEJM.org). Azithromycin, methylprednisolone in
a tapering dose, and an otic solution of neomycin,
polymyxin B, and hydrocortisone were prescribed,
but the patient discontinued the glucocorticoid
because of insomnia. The pain resolved,
but blockage persisted; on follow-up by an otolaryngologist
3 days later, myringotomy with tube
placement was performed and ciprofloxacin and
dexamethasone drops were prescribed. The patient
was advised to keep water out of the ear.
On follow-up 3 weeks later , the patient reported improved hearing
and no pain. On examination, abundant debris
was found and removed from the left ear canal;
dried serous material covered the left tympanic
membrane, and granulation tissue obstructed the
lumen of the tube. The speech-reception threshold
was in the 35-dB range; other findings were unchanged.
The tube was removed and the middle
ear was aspirated, without evidence of purulence.