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| TEACHING IMAGES |
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| Year : 2013 | Volume
: 1
| Issue : 1 | Page : 93-94 |
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A case of unilateral spontaneous hemotympanum
KS Gangadhara Somayaji1, Aroor Rajeshwary2, Zainab Sunu Ali1, Akhila Shetty1
1 Yenepoya Medical College, Mangalore, India
2 Department of ENT, K S Hegde Medical Academy, Mangalore, India
| Date of Web Publication | 21-Jun-2013 |
Correspondence Address:
K S Gangadhara Somayaji
Department of ENT, Yenepoya Medical College, Mangalore
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.113594
How to cite this article:
Gangadhara Somayaji K S, Rajeshwary A, Ali ZS, Shetty A. A case of unilateral spontaneous hemotympanum. Arch Med Health Sci 2013;1:93-4 |
| Case Report | |  |
An 18-year-old lady presented to ENT department with history of recurrent unilateral headache associated with nausea since 3 years. There were no other ENT complaints. On right ear examination, a bulge was seen in the bony posterior superior canal wall adjacent to the tympanic membrane obscuring the view of pars flaccida. Hemorrhagic blebs were seen in the middle of the pars tensa, the remaining portion of which was bluish [Figure 1]. Tuning fork tests revealed mild right conductive hearing loss. Pure tone audiogram confirmed the conductive hearing loss at low frequency (23 dB). Tympanogram revealed 'B' curve. All the bleeding parameters were normal. A probable diagnosis of cholesterol granuloma or hemotympanum was made. An exploratory tympanotomy was done to find out any middle ear pathologies [Figure 2]. Thin brownish fluid was sucked out from the middle ear. There was no glue, no mass lesion, no congenital abnormalities nor any fracture lines detected in middle ear. The postoperative period was uneventful. However, after 3 weeks, patient presented with similar appearance of the tympanum membrane. She underwent a myringotomy with grommet insertion. After 4 months, patient is still asymptomatic, with grommet in situ, with minimal bluish discoloration of the ear drum. | Figure 1: Showing the postero-superior bulge in the canal and bleb over the pars tensa of the tympanic membrane
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| Discussion | | |
The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders, vascular tumors and blunt trauma to the head, especially when temporal bone fracture occurs. [1] A rare case has followed septoplasty. [2] All the reported cases are of bilateral hemotympanum. Our case had unilateral collection. Hemotympanum may be easily diagnosed by otoscopy, appearing as partial or total occupancy of the tympanic membrane by bright red, or purple - dark blue color. [1] Evidence suggests that secretory otitis media and spontaneous hemotympanum are different phases of the same disease process. [3] Eustachian tube dysfunction may be the cause in some cases secondary to peritubal lymphatic stasis. [4] From one point of view, idiopathic hemotympanum is not a specific disease but 'a phase of otitis media with effusion. [5] Imaging may be required to rule out known causes of bleeding. [3] Treatment is usually conservative with antibiotics and nasal decongestants. Myringotomy with ventilation tube insertion may be required if the condition persists after one month. 1 If unresolved, there is a tendency to develop cholesterol granuloma and may require cortical mastoidectomy. [5]
| References | | |
| 1. | Fidan V, Ozcan K, Karaca F. Bilateral hemotympanum as a result of spontaneous epistaxis. Int J Emerg Med 2011;4:3. 
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| 2. | Lee JH. Bilateral hemotympanum secondary to septoplasty. Ear Nose Throat J 2012;9:350.
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| 3. | Balatsouras DG, Dimitropoulos P, Fassolis A, Kloutsos G, Economou NC, Korres S, et al. Bilateral spontaneous hemotympanum: Case report. Head Face Med 2006;2:31.
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| 4. | McCurdy JA Jr. Effects of nasal packing on Eustachian tube function. Arch Otolaryngol 1977;103:521-3.
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| 5. | Maeta M, Saito R, Nagakawa F, Miyahara T. Surgical intervention in middle ear cholesterol granuloma. J Laryngol Otol 2003;117:344-8.
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[Figure 1], [Figure 2]
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