When the envelope pushes back: a combat aviator experiences barotrauma after descending with an ear block.

While deployed to a war zone, an aviator displayed poor aeromedical judgment and flew with an upper respiratory infection and an ear block. This resulted in a tympanic membrane perforation and the medical grounding of the member for 10 days. The discussion involves the probable mechanism of injury and the requirements of the Naval Aerospace Medical Institute regarding perforations, as well as the reasoning behind the flight surgeon's choice of treatment.