Unusual cause of acute tympanic perforation: a case report with brief literature review

Abstract

Introduction

Tympanic membrane perforations (TMPs) are common in otolaryngology and result from infections, trauma, or Eustachian tube dysfunction. Traumatic causes include slap injuries, explosive blasts, barotrauma from activities such as scuba diving or rapid altitude changes, iatrogenic injuries during ear procedures, foreign bodies, skull base fractures, and significant pressure changes during air travel or forceful Valsalva maneuvers. Symptoms often include otorrhea, otalgia, and tinnitus. Most TMPs heal spontaneously with supportive care.

Case presentation

A 28-year-old trumpet player with intermittent allergic rhinitis experienced sudden right ear pain and hearing loss after a prolonged rehearsal. Examination revealed a central perforation of the right tympanic membrane and conductive hearing loss. The diagnosis was an acute traumatic tympanic membrane perforation due to barotrauma from forceful trumpet playing, exacerbated by subclinical Eustachian tube dysfunction and allergic rhinitis. Conservative management led to spontaneous healing within six weeks, and a gradual return to playing was advised.

Discussion

Tympanic membrane perforation (TMP) is typically linked to infections, trauma, or barotrauma. This case highlights a novel occupational cause in a 28-year-old trumpet player, where high intraoral pressures generated during forceful playing, exacerbated by subclinical Eustachian tube dysfunction (ETD) and allergic rhinitis, led to TMP. Prolonged rehearsals caused cumulative pressure buildup that exceeded the tensile strength of the tympanic membrane (TM). Conservative management, including water precautions and abstaining from instrument play, resulted in spontaneous healing. Musicians, particularly brass players, should be educated about ETD risks. Preventive strategies, such as allergy management and modified breathing techniques, are essential to mitigate injury risks in wind instrumentalists.

Conclusion

This report underscores occupational barotrauma as a cause of TMP among wind musicians. Clinicians should evaluate ETD and allergies in symptomatic players. Preventive strategies and research on the effects of instrument-generated pressures can inform safer playing techniques.