The patient is a 49 year old male who presented with a unilateral (AD) loss of hearing after vigorously blowing his nose. Video otoscopic examination revealed a posterior marginal perforation with TM edges folded back upon itself giving the appearance that the annulus itself was avulsed. Figure 1 shows a posterior marginal perforation, AD, due to vigorous nose-blowing. Figure 2 audiogram shows the resulting conductive loss, AD. Case contributed by Kevin Pons, M.S., FAAA; Yankton Medical Clinic; Yankton, SD posted June 1, 2001