Hyperectasis of the Tympanic Membrane
A 44-year-old woman presented with bilateral ear fullness. She had been given a diagnosis of atelectatic tympanic membranes several years earlier and had been advised to perform the Valsalva maneuver, which raises the air pressure in the nasal cavity and aerates the middle-ear cavity through the eustachian tube, leading to temporary disappearance of the sensation of ear fullness. She continued to perform the Valsalva maneuver four times a day for 6 years. On examination, the tympanic membranes were ballooned outward with no signs of effusion or inflammation in the tympanic cavity (Panels A and B; 5 hours after the last Valsalva maneuver). An audiogram (Panel C) showed mild conductive hearing loss on the right (o symbols) and normal hearing level on the left (x symbols); the brackets delineate the normal range. Bilateral hyperectasis of the tympanic membrane was diagnosed, most likely resulting from excessive performance of the Valsalva maneuver. The patient was directed to perform the maneuver gently only once a day as needed. The ballooning of the tympanic membranes diminished 1 month later.
