Hyperectatic Herniation of the Tympanic Membrane With Adenoid Vegetation

A 31-year-old woman presented with intermittent otalgia in the right ear, reporting severe pain during flights. The patient denied performing habitual Valsalva maneuvers. Otoendoscopic examination revealed hyperectatic herniation of the posterior portion of the right tympanic membrane (TM). Nasopharyngoscopy showed adenoid vegetation, and tympanometry demonstrated an abnormally high peak, indicating a thinned TM. The temporal bone CT was unremarkable, but a CT of the paranasal sinuses revealed a mild homogeneous lesion in the nasopharynx. The patient underwent adenoidectomy and right ventilation tube insertion, leading to significant improvement in TM herniation. This case suggests that hyperectatic herniation may occur due to impaired Eustachian tube function and recurrent otitis media, even in the absence of habitual Valsalva maneuvers. Unlike most previous reports associating TM bulging with Valsalva maneuvers, this case highlights other factors, such as barotrauma from flying, which may also contribute. Treatment options should be based on the severity of TM bulging, with observation or reduced Valsalva frequency in mild cases and ventilation tube insertion or other surgical intervention in severe cases. Further investigation into optimal management strategies for hyperectatic herniation of the TM is warranted, considering individual patient history and contributing factors.