Sudden Hearing Loss: Concert Pianist with Round Window Membrane Rupture

Figure

a) Barotrauma-related rupture of the round window membrane near the round window niche (arrow), microscopically verified by exploratory tympanotomy. The round window membrane, or a pseudomembrane, is visible, which may also be incompletely attached. The intraoperative finding of a perilymph leak is regarded as a classic indirect sign of round window membrane rupture. b) Schematic illustration showing the anatomical relationship of the marked open round window niche to the cochlea (asterisk) and the middle ear (diamond symbol).

A 54-year-old international concert pianist presented to our dedicated musicians’ outpatient clinic with severe left-sided sensorineural hearing loss that had suddenly developed while landing during a business trip a week earlier. Oral glucocorticoid treatment initiated by an ENT specialist 48 hours after the event had not resulted in either subjective hearing improvement or corresponding audiometric improvement. Based on a history suggestive of barotrauma with rupture of the round window membrane, we decided to perform an exploratory tympanotomy on the eighth day after the event, which confirmed the rare membrane lesion associated with leakage of perilymph fluid. During surgery, the round window membrane was covered with connective tissue soaked in dexamethasone phosphate. After four weeks, audiometry demonstrated marked improvement in the high-frequency range, less so in the low- and middle-frequency ranges. Given the now-moderate sensorineural hearing loss, professional concert performances should, in principle, be possible again with normal hearing in the right ear and a successful hearing-aid fitting in the left ear. This case underscores that exploratory tympanotomy with coverage of the round window membrane is justified for refractory barotrauma-associated severe hearing loss or deafness, with the literature suggesting that early intervention increases the chances of success.

Prof. Dr. med. Katharina Stölzel, Prof. Dr. med. Marc Bloching, Klinik für HNO-Heilkunde, Helios Klinikum Berlin-Buch, Medical School of Berlin, [e-mail]

Prof. Dr. med. Philipp P. Caffier, Klinik für Audiologie und Phoniatrie, Berliner Centrum für Musikermedizin, Charité – Universitätsmedizin Berlin

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Dr Grahame Larkin.

Cite this as: Stölzel K, Bloching M, Caffier PP: Sudden hearing loss: Concert pianist with round window membrane rupture. Dtsch Arztebl Int 2026; 123: 373. DOI: 10.3238/arztebl.m2026.0075