Foundation

A 4-year-old with a blocked-ear sensation

A 4-year-old is brought in after recurrent colds. Hearing seems reduced. Otoscopy shows a dull, retracted drum without an obvious perforation.

Investigations

Audiogram

0204060801001202505001k2k4k8kFrequency (Hz)Hearing level (dB HL)[[[[[[ air conduction[ bone conduction

Tympanogram

-400-300-200-10001002000.00.51.01.52.02.53.0Ear-canal pressure (daPa)Admittance (mmho)

Flat tympanogram, normal equivalent ear-canal volume, absent ipsilateral reflexes.

Which interpretation best fits this tympanogram?