Bilateral tympanic membrane perforation during bronchoscopy in an intensive care unit patient: a case report

Bronchoscopy is a fundamental and generally safe interventional procedure in respiratory medicine, with recognized complications being predominantly confined to the airways. Traumatic tympanic membrane perforation, while a common form of barotrauma, is exceptionally rarely associated with bronchoscopy. This report describes a case of bilateral tympanic membrane perforation complicating bronchoscopy, aiming to enhance clinicians'awareness of this uncommon iatrogenic injury.

A 77-year-old man presented with cough and shortness of breath. Emergency investigations revealed a large left-sided pleural effusion, bilateral pneumonia, significantly elevated inflammatory markers, and type I respiratory failure. Following initial stabilization in the intensive care unit, bedside bronchoscopy was performed for microbiological diagnosis. During the procedure, the patient experienced sudden onset of bilateral otalgia and ear bleeding. Urgent otolaryngology consultation confirmed bilateral central tympanic membrane perforations. Conservative management with observation was adopted due to the small size of the perforations. Subsequent etiological investigation indicated a mixed pulmonary infection. The patient was discharged in a stable condition after targeted antimicrobial therapy, and both tympanic membrane perforations healed spontaneously without residual hearing deficit.

This case illustrates that bronchoscopy can, in rare instances, lead to bilateral traumatic tympanic membrane perforation, a presentation potentially more severe than the unilateral injury previously reported. This complication likely results from procedure-induced cough generating abrupt pressure changes transmitted via the Eustachian tubes and may occur more frequently in elderly, critically ill, or less cooperative patients. Clinicians should maintain vigilance for this potential complication. Optimizing sedation-analgesia protocols should be considered for high-risk individuals to aid prevention. When it occurs, small perforations can often be managed successfully with conservative measures, underscoring the importance of timely multidisciplinary collaboration.