Bulging tympanic membrane.

A 67-year-old man complained that he had to pop his ears in order to hear normally. On examination, his tympanic membranes were thin and bulging in the posterosuperior quadrant, a result of his habitually performing the Valsalva maneuver (figure). His audiogram revealed normal hearing at frequencies from 250 to 1,000 Hz. At 2,000 and 3,000 Hz, his hearing level dropped to 35 and 45 dB, respectively. Findings on tuning-fork testing and the remainder of the ENT examination were normal.

At the House Clinic, we often see patients who believe that they must clear their ears frequently in order to improve their hearing. These patients typically have a high-tone hearing loss. By increasing the tension on the tympanic membrane, they improve the high-frequency transmission of sound through the eardrum and middle ear. They achieve an improvement of approximately 10 to 20 dB at the higher frequencies. Placing a ventilation tube in the tympanic membrane does not help these patients; in fact, it might worsen the situation. We explain this to patients and instead recommend high-frequency-response, open mold-fitting hearing aids.

Jose N. Fayad, MD; John W. House, MD

From the House Ear Clinic and the Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles.