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Intratympanic Hemorrhage and Concussion in a Football Offensive Lineman

      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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      References

        • Mirza S.
        • Richardson H.
        Otic barotrauma from air travel.
        J Laryngol Otol. 2005; 119: 366-370
        • Harrison D.
        • Lloyd-Smith R.
        • Khazei A.
        • Hunte G.
        • Lepawsky M.
        Controversies in the medical clearance of recreational scuba divers: updates on asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale.
        Curr Sports Med Rep. 2005; 4: 275-281
        • Carlson S.
        • Jones J.
        • Brown M.
        • Hess C.
        Prevention of hyperbaric-associated middle ear barotrauma.
        Ann Emerg Med. 1992; 21: 1468-1471
        • Gondusky J.S.
        • Reiter M.P.
        Protecting military convoys in Iraq: an examination of battle injuries sustained by a mechanized battalion during Operation Iraqi Freedom II.
        Mil Med. 2005; 170: 546-549
        • Gutierrez de Ceballos J.P.
        • Turégano Fuentes F.
        • Perez Diaz D.
        • Sanz Sanchez M.
        • Martin Llorente C.
        • Guerrero Sanz J.E.
        Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings.
        Crit Care Med. 2005; 33: S107-S112
        • Xydakis M.S.
        • Fravell M.D.
        • Nasser K.E.
        • Casler J.D.
        Analysis of battlefield head and neck injuries in Iraq and Afghanistan.
        Otolaryngol Head Neck Surg. 2005; 133: 497-504
        • Bernhardt D.T.
        • Roberts W.O.
        Preparticipation physical examination.
        4th edn. American Academy of Pediatrics, Elk Grove Village, IL2010
        • Cave K.
        • Cornish E.M.
        • Chandler D.W.
        Blast injury of the ear: clinical update from the global war on terror.
        Mil Med. 2007; 172: 726-730
        • Jensen J.H.
        • Bonding P.
        Experimental pressure-induced rupture of the tympanic membrane in man.
        Acta Otolaryngol. 1993; 113: 62-67
        • Xydakis M.S.
        • Bebarta V.S.
        • Harrison C.D.
        • Conner J.C.
        • Grant G.A.
        • Robbins A.S.
        Tympanic-membrane perforation as a marker of concussive brain injury in Iraq.
        N Engl J Med. 2007; 357: 830-831

      Linked Article

      • Errata
        Journal of Emergency MedicineVol. 47Issue 3
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          Kevin N. Waninger, MD, MS, Brian M. Gloyeske, ATC, John M. Hauth, ATC, EDD, Keith A. Vanic, ATC, PHD, and David M. Yen, MD. Intratympanic hemorrhage and concussion in a football offensive lineman. J Emerg Med 2014;46(3);371-2.
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