Hematotympanum in Adult
There are many possible causes of hematotympanum. The most common causes typically involve trauma. Hemotympanum can be seen from cotton swab (eg, Q-tip) injuries and in the context of more severe head trauma where a temporal bone fracture is present. Barotrauma from diving or from flying are also common causes.
Another cause of hemotympanum is epistaxis, which can lead to eustachian tube dysfunction and retrograde blood flow into the middle ear cavity. Therapeutic nasal packing and surgical procedures such as septoplasty can also lead to retrograde flow of blood into the inner ear. Abnormalities of coagulation can lead to bilateral hemotympanum. This can be seen in the context of oral anticoagulation medications, conditions that affect the hematologic system such as leukemia and lymphoma, or chemotherapeutic medications.
A paraganglioma, a vascular tumor of the middle ear, can mimic the appearance of hemotympanum. Abnormalities of the carotid artery, including aneurysm or aberrant course through the petrous portion of the temporal bone, can also mimic the appearance of blood in the middle ear.
Given the variability of causes, this condition can affect people of all demographics and locations.
H74.8X9 – Other specified disorders of middle ear and mastoid, unspecified ear
111536009 – Hematotympanum
- Otitis media – characterized by fever, ear pain, possibly otorrhea
- Epistaxis, therapeutic nasal packing, and septoplasty – can be revealed through a thorough history
- Hematologic conditions – abnormal complete blood count (CBC); elevated prothrombin time (PT) and partial thromboplastin time (PTT)
- Anticoagulant medications – can be revealed through a thorough history; elevated PT and PTT
- Cancer chemotherapy – can be revealed through a thorough history
- Paraganglioma – seen via magnetic resonance imaging
- Abnormalities of the carotid artery – seen via computed tomography scan with intravenous contrast
- Temporal bone fracture and skull base fracture – trauma will be revealed through a thorough history and CT can confirm presence of fractures
- Strangulation and barotrauma – can be revealed through a thorough history