Hindawi Publishing Corporation Case Reports in Medicine Volume 2010, Article ID 856045, 3 pages doi:10.1155/2010/856045 Case Report Clinical Presentation and Conservative Management of Tympanic Membrane Perforation during Intrapartum Valsalva Maneuver Jonathan D. Baum,1 Meghan I. Rattigan,1 Eric Scott Sills,2 and Anthony P. H. Walsh2 1 Department of Obstetrics and Gynecology, Jersey Shore University Medical Center, 1944 State Route 33, Second Floor, Neptune, NJ 07753, USA 2 Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Correspondence should be addressed to Jonathan D. Baum, muab@aol.com Received 4 January 2010; Accepted 29 January 2010 Academic Editor: Frans J. Walther Copyright © 2010 Jonathan D. Baum et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Tympanic membrane perforation may occur when ear pressures are excessive, including valsalva maneuver associated with active labor and vaginal delivery. A pressure diﬀerential across the eardrum of about 5 psi can cause rupture; the increased intraabdominal pressure spikes repeatedly manifested by “pushing” during second-stage labor easily approach (and may exceed) this level. Material and Method. We describe a healthy 21-year old nulliparous patient admitted in active labor at 39-weeks’ gestational age. Results. Blood appeared asymptomatically in the left ear canal at delivery during active, closed-glottis pushing. Otoscopic examination conﬁrmed perforation of the left tympanic membrane. Complete resolution of the eardrum rupture was noted at postpartum check-up six weeks later. Conclusion. While the precise incidence of intrapartum tympanic membrane rupture is not known, it may be unrecognized without gross blood in the ear canal or subjective hearing loss following delivery. Only one prior published report on tympanic membrane perforation during delivery currently appears in the medical literature; this is the ﬁrst English language description of the event. Since a vigorous and repetitive valsalva eﬀort is common in normal vaginal delivery, clinicians should be aware of the potential for otic complications associated with the increased intraabdominal pressure characteristic of this technique. 1. Background Rupture of the tympanic membrane can result from any pressure or stress exerted on the ear. The vigorous and repetitive valsalva eﬀorts of active labor can yield internal ear pressures that exceed the safe threshold for tympanic membrane integrity, causing intrapartum injury to the eardrum. Intrapartum tympanic membrane rupture appears to be encountered with low frequency, although under- reporting could be a result of inadequate clinical familiarity and minimal awareness of the condition. 2. Clinical Presentation A 21-year-old nonsmoking nullipara presented at 39-weeks’ gestation in active labor. Her prenatal course was unre- markable; results from all routine prenatal laboratory tests were normal. The patient had no prior ear infections, tympanoplasty or other surgery, and her baseline evaluation identiﬁed no deﬁcit in hearing acuity. With the exception of prenatal vitamins, she took no regular medications. Social history was negative for diving, mountainclimbing, skydiv- ing or other activities at barometric pressure extremes. Intra- venous oxytocin was not indicated for labor augmentation. Fetal status remained reassuring and the patient achieved full cervical dilation and eﬀacement within 90 min of admission. Neither neuraxial anaesthesia nor intravenous narcotics were required for pain management. Upon conﬁrmation of full cervical dilation, the patient began closed-glottis pushing simultaneous with uterine contractions. Following a 32-minute second stage of labor, she delivered a viable male infant over a mediolateral episiotomy. Five and ten minute Apgar scores were 9 and 9; birth weight was 3291 g. The placenta was delivered spontaneously and intact. The episiotomy was repaired routinely. Intrapartum blood loss was approximately 300 mL.