Abstract
Background
A 26-year-old arena football lineman participating in a “bull in the ring” blocking
and tackling drill was blindsided by an opposing teammate. He sustained a direct helmet-to-helmet
blow to the right temporal area.
Objectives
This case describes a unique mechanism of ear barotrauma (intratympanic hemorrhage)
and concussion caused by helmet-to-helmet contact in American football.
Case Report
Initial sideline evaluation revealed mild headache, confusion, dizziness, photophobia,
and tinnitus, all consistent with a concussion diagnosis. Physical examination revealed
a large postauricular contusion over the right mastoid process and diffuse right intratympanic
hemorrhage on examination. No hemotympanum or effusion of the middle ear was noted.
Abnormalities were seen on vestibular testing and visual accommodation and convergence
testing. Computed tomography and magnetic resonance imaging were performed with attention
to the temporal bones and were normal. Neuropsychological testing was abnormal compared
to baseline. Audiology testing was within normal limits. Diagnosis was intratympanic
hemorrhage secondary to barotrauma caused by helmet-to-helmet contact, with mastoid
contusion and season-ending concussion.
Conclusions
The tympanic membrane (TM) is a highly vascular membrane that is very sensitive to
variations of atmospheric pressure. Overpressure can enter the external auditory canal,
stretching and displacing the TM medially and causing injury to the tympanic membrane
secondary to barotrauma. This concussed football player was never able to return to
play due to his postconcussive symptoms. He had no residual hearing or ear problems.
Keywords
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Article info
Publication history
Published online: October 24, 2013
Accepted:
August 15,
2013
Received in revised form:
May 13,
2013
Received:
December 2,
2012
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
