Introduction:
The human ear is a marvel of intricacy and function, serving as a gateway to the world of sound. However, like any other part of the body, it is susceptible to various ailments and conditions that can disrupt its normal functioning. One such condition is hemotympanum, an uncommon but distinct occurrence that affects the middle ear.
What Is Hemotympanum?
Hemotympanum refers to the presence of blood in the middle ear behind the ear drum. The blood is trapped behind the eardrum (tympanic membrane). Therefore, the patient would not see the blood coming out of the ear. Hemotympanum is usually linked with an underlying disease, therefore, it is important to tell the noticeable symptoms to the doctor.
What Are the Causes of Hemotympanum?
The causes of hemotympanum include -
1. Basal Skull Fracture -
It is a fracture of one of the bones of the skull, which can happen due to trauma such as head injury, fall, or accident. Also, if the temporal bone gets involved, it causes the hemotympanum. Along with that patient can also have the following conditions such as -
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Leaking of cerebrospinal fluid (CSF) from the ear.
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Bruising around the eyes or ears.
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Dizziness (sensation of spinning and losing balance).
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Facial muscle weakness.
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Difficulty in seeing, smelling, or hearing things.
Skull fractures can be serious if not treated early, and in some cases, with a blunt or minor injury, it gets healed on its own. But it is always advised to get medical advice as it can cause several complications. For example, if a person has cerebrospinal fluid leakage from the ear, they have a higher chance of developing meningitis (inflammation and infection of the brain and spinal cord membranes).
2. Ear Infections -
Patients with frequent ear infections, ongoing inflammation, and fluid buildup in their ears have a high chance of developing hemotympanum. In that case, immediate medical assistance is needed, and the patient has to cooperate with the healthcare professional to formulate a treatment plan for recurring ear infections. Most cases are treated with antibiotics, and surgery may also be needed in severe cases.
3. Nasal Packing -
In case a patient has a recent surgery around the nose or frequently gets a bloody nose, the doctor may insert gauze or cotton in the nose to stop bleeding, called nasal packing. The nasal packing, in some cases, can cause the blood to back up in the middle ear leading to the hemotympanum. The patient should consult the doctor immediately if they feel any symptoms related to the hemotympanum. Then the doctor can remove the packing to drain the blood out of the ear. Moreover, antibiotics can also be prescribed to treat the infection.
4. Bleeding Disorders -
Bleeding disorders can also lead to hemotympanum, such as hemophilia (a bleeding disorder in which blood does not clot). Blood disorders prevent blood from clotting and make a person prone to bleeding. Patients with bleeding disorders can have hemotympanum even with mild head injury or sneezing. Therefore patients should be honest with their doctor related to any underlying diseases.
5. Anticoagulant Medications -
Anticoagulants are medications that help in keeping the blood from clotting. These are also known as blood thinners. They are mostly used to treat blood clots in the body. In rare cases, anticoagulants can also cause hemotympanum without any underlying condition. In that case, the patient is advised to stop taking anticoagulants and let the ear heal. But it is always advised not to stop taking any medication without consulting the doctor. Moreover, antibiotics may also have to be prescribed to treat the infection.
Other than that, some of the following can also lead to hemotympanum such as -
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Chronic otitis media (recurrent infection of the middle ear).
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Vascular lesions such as glomus tympanicum (the most common middle ear cancer).
What Are the Symptoms of the Hemotympanum?
The most common symptoms of hemotympanum include -
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Headache.
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Pain.
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Hearing loss.
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Dizziness or vomiting.
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Sense of fullness in the ear.
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Bruising behind the ear (Battle's sign).
Some patients can also be asymptomatic.
What Are Various Clinical Presentations of the Hemotympanum?
The blood in the middle ear gives different clinical presentations depending on how long the blood has been there. It can be clinically seen with the help of an otoscope (a medical device used to look inside the ear).
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The presence of fresh blood in the middle ear gives the tympanic membrane or ear drum a red color.
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The presence of old blood in the middle ear makes the tympanic membrane black or dark purple.
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When the hemoglobin in the blood starts to degrade with time, the bloody fluid turns to a brownish color. The tympanic membrane is referred to as the chocolate eardrum at that stage.
How Is Hemotympanum Diagnosed?
Hemotympanum cannot be seen with the naked eye. For this, some tests and imaging techniques can be used to check for bleeding in the middle ear. The healthcare professional will start with an otoscopy evaluation of the tympanic membrane or ear drum. An audiogram may also be needed to check for any hearing loss. If any hearing problems are noticed, the healthcare professional may advise a CT (computed tomography) to check for any discoloration behind the eardrum. MRI (magnetic resonance imaging) may also be needed to confirm the cause of blood discoloration.
Some of the indications for imaging tests include -
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History of recent head trauma.
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Abnormal middle ear mass (pulsatile mass).
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Congenital vascular anomalies.
What Is the Treatment for Hemotympanum?
Generally, the cause of hemotympanum includes bone fractures, nasal packing, anticoagulant therapy, and infections like chronic otitis media. The treatment for hemotympanum is usually conservative, which involves monitoring the situation.
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Prophylaxis antibiotics are the other option that can be prescribed to treat any infections.
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Myringotomy (surgical procedure in which incision is made on ear drum) tube may also be used in patients with persistent effusion (buildup of excessive fluid) to prevent long-term complications.
Patients with hemotympanum usually require an ear, nose, and throat specialist to evaluate the underlying cause.
Conclusion
Hemotympanum is a non-serious condition that can be treated easily. However, if the blood stays in the ear for too long, it can cause various complications, such as ear infections. Therefore, patients should be aware of any symptoms and should report to the doctor if they experience any symptoms related to the hemotympanum.
