Tympanostomy Tube Shorthand and Differentiating Hemotympanum from Barotrauma Erythema
Tympanostomy tubes are commonly abbreviated as "PE tubes" (pressure equalization tubes) or "T-tubes," and you can differentiate hemotympanum from simple erythema by looking for blood behind or within the tympanic membrane versus superficial redness—hemotympanum appears as a blue-black or dark red discoloration with visible blood, while barotrauma erythema shows diffuse redness without blood accumulation 1.
Shorthand Terminology
The most widely used abbreviations for tympanostomy tubes include:
- PE tubes (pressure equalization tubes)
- T-tubes
- Grommets (particularly in British terminology)
- Myringotomy tubes 1
Differentiating Hemotympanum from Barotrauma Erythema
Key Distinguishing Features on Otoscopic Examination:
Hemotympanum characteristics:
- Blue-black, dark red, or purple discoloration visible through the tympanic membrane
- Blood is present either in the middle ear cavity OR within the layers of the tympanic membrane itself (intra-tympanic membrane hemorrhage)
- The blood appears as a fluid level or pooled collection behind the membrane
- May see hemorrhage between the TM annulus and epidermal layer 2
- Associated with conductive hearing loss (though minimal in intra-TM hemorrhage cases)
- Often accompanied by aural fullness, otalgia, and sometimes bloody otorrhea 3, 2
Simple erythema from barotrauma:
- Diffuse redness of the tympanic membrane surface
- No visible blood collection behind or within the membrane
- The membrane remains translucent enough to see middle ear structures
- Represents vascular congestion or inflammation of the TM itself
- Usually no or minimal hearing loss 2
- May have injection of vessels along the malleus handle
Clinical Context Matters:
Both conditions can occur from barotrauma (diving descent, Valsalva during childbirth, etc.) 3, 2, 4. The critical difference is:
- Erythema alone = vascular response without vessel rupture
- Hemotympanum = actual bleeding with blood accumulation
Common Pitfall to Avoid:
Don't confuse intra-tympanic membrane hemorrhage (blood within the TM layers) with middle ear hemotympanum (blood in the cavity). Both appear as blood on examination, but intra-TM hemorrhage shows bleeding between the TM annulus and epidermal layer without soft tissue density in the tympanic cavity on CT, while true middle ear hemotympanum fills the cavity 2.
Management Implications:
Both conditions typically resolve spontaneously within 1 month without specific treatment 2. However, if you see hemotympanum with new hearing disturbance or bloody otorrhea, particularly post-trauma or post-barotrauma event, prompt otolaryngology evaluation is warranted 3.