These AD and AS VO images [inline below (23k, 18k)] were obtained from a 52 year old adult male patient with Down's Syndrome and a history of long-standing bilateral chronic middle ear disease, dormant at present on AD with more recent episodes of serous OM on AS. AD VO demonstrates a subtotal perforation in an essentially dry ear with a vivid display of the ossicular chain.

AS VO shows a Richards "T" PE tube, implanted just under 2 years ago, in the process of extrusion.

Pure tone audiometry (36k) reveals a moderate, mixed, essentially sensorineural loss of hearing. Flat (Type B) tympanograms (43k) were obtained bilaterally with PVTeq of 2.6 ml AD and 1.7 ml AS. A nine-year old CLASS II (vented) half-concha, hearing aid, non-functional at time of evaluation, was worn in AS.