Rosh Pediatrics Practice Exam

A child with a history of recurrent otitis media presents with a retraction pocket in the tympanic membrane. What is the likely predisposing factor?

1. Being a member of the wrestling team

2. History of recurrent otitis media

3. Recent travel on an airplane

4. Swimming daily in a pool

The correct answer is: History of recurrent otitis media

A retraction pocket in the tympanic membrane is often a sign of Eustachian tube dysfunction, which can be associated with negative middle ear pressure leading to retraction of the tympanic membrane. In the context of a child with recurrent otitis media, the history of frequent infections can contribute to the development of this condition. Recurrent otitis media generally indicates that there has been repeated inflammation or infection in the middle ear, which can affect the normal functioning of the Eustachian tubes. This dysfunction can prevent equalization of pressure and lead to the negative pressure that results in the retraction pocket. Other factors listed may contribute to ear issues but do not have a direct connection to the chronicity of middle ear infections that predispose to retraction pockets. For instance, while swimming can introduce water into the ear canal, it is not specifically associated with the development of retraction pockets linked to Eustachian tube dysfunction when compared to the recurring effects of multiple otitis media episodes. Thus, a history of recurrent otitis media clearly stands out as the most pertinent predisposing factor for this child's condition.