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This patient is a 42 year old male who complained of having a whistling out of his ear when he blew his nose.  On examination he had a very small pinhole perforation.  The eardrum was mobile and he could aerate his middle ear with valsalva.  When he did this, the eardrum distended and a small perforation opened and a whistling could be heard as air escaped from the middle ear.  This is one of the few cases where an eardrum perforation was present and the eardrum was still mobile to changes in air pressure.