title: 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.
  
  
  OBJECTIVE
  This case describes a unique mechanism of ear barotrauma (intratympanic hemorrhage) and concussion caused by helmet-to-helmet contact in American football.
  
  
  METHODS
  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.
authors.affiliation: St. Luke's University Hospital and Health Network, Bethlehem, Pennsylvania; East Stroudsburg University Athletic Training, East Stroudsburg, Pennsylvania.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Waninger
authors.affiliation: East Stroudsburg University Athletic Training, East Stroudsburg, Pennsylvania.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Gloyeske
authors.affiliation: East Stroudsburg University Athletic Training, East Stroudsburg, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Hauth
authors.affiliation: East Stroudsburg University Athletic Training, East Stroudsburg, Pennsylvania.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Vanic
authors.affiliation: St. Luke's University Hospital and Health Network, Bethlehem, Pennsylvania.
authors.forename: David M
authors.initials: DM
authors.lastname: Yen
mesh_terms: D000328:Adult; D001469:Barotrauma / Q000150:complications*; D001924:Brain Concussion / Q000175:diagnosis / Q000209:etiology*; D004427:Ear Diseases / Q000175:diagnosis / Q000209:etiology*; D005538:Football / Q000293:injuries*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D014432:Tympanic Membrane / Q000293:injuries*
keywords: barotrauma; ear trauma; football; head injury; intratympanic hemorrhage