A 45-year-old female veteran presents to the VA with concerns for decreased hearing.
The veteran has a subtle tympanic membrane rupture/erosion.
In addition, it looks like she has had trauma to the ear in the past; the eardrum architecture is distorted and there is evidence of sclerosis. An interesting observation – when the patient performed a Valsalva maneuver, bubbling was evident at the site of the membrane rupture. In a cooperative patient, the Valsalva is helpful in observing the movement of the tympanic membrane without pneumatic otoscopy.