A 50-year-old man presented to the ear, nose, and throat casualty clinic with bleeding
from the left external auditory meatus. He had undergone upper gastrointestinal endoscopy
that morning without the use of a local anaesthetic throat spray or sedation. During
the procedure, it was noted that the patient was gagging excessively, following which
he experienced a searing pain in the left ear. On questioning, the patient stated
that he had been suffering from a coryzal-type illness for the previous week and still
had a blocked nose. Before this episode, he had not experienced any problems with
his ears. On examination of the left ear, a small perforation was found on the anterior
portion of the pars tensa. A diagnosis of tympanic perforation following upper gastrointestinal
endoscopy was made, and the patient was treated with antibiotic ear drops for 1 week
to prevent any secondary infection. No follow-up appointment was arranged [1].
The tympanic membrane perforation appears to have been due to positive pressure within
the middle ear after the inadvertent performance of a forced Valsalva manoeuvre. There
was a sudden over-admittance of air via the Eustachian tube to the tympanic cavity,
causing lateral displacement of the tympanic membrane. In less severe cases, this
would have caused hyperaemia, oedema, and ecchymosis. Valsalva manoeuvres are known
to cause occasional perforations, but there is no previously documented evidence that
a tympanic perforation has ever resulted from a gastrointestinal endoscopic procedure.
The event was most likely due to a combination of factors, such as the lack of sedation
and the incidental coryzal illness, leading to excessive gagging against a closed
system.
Figure 1 A small perforation is seen on the anterior portion of the pars tensa of the left
ear. There is a small amount of bleeding, collecting both behind the tympanic membrane
and in the external auditory canal.
Endoscopy_UCTN_Code_CPL_1AH_2AB
