What is the medical term for bleeding into the middle ear canal?

Medical Term for Bleeding into the Middle Ear Canal

The medical term for bleeding into the middle ear canal is hemotympanum.

Definition and Characteristics

Hemotympanum refers to the presence of blood in the middle ear cavity and/or ecchymosis (bruising) of the tympanic membrane. It is characterized by:

• Blood or blood products accumulated behind an intact tympanic membrane
• A bluish or purplish discoloration of the tympanic membrane on otoscopic examination
• May be associated with hearing loss, ear fullness, or otalgia (ear pain)

Etiology

Hemotympanum can result from several causes:

1. Trauma

   • Blunt head trauma
   • Barotrauma (pressure injuries during flying or diving)
   • Temporal bone fractures
   • Iatrogenic injury during ear procedures

2. Non-traumatic causes

   • Blood dyscrasias or coagulopathies
   • Spontaneous hemorrhage
   • Chronic otitis media with effusion and bloody discharge
   • Vascular anomalies (e.g., dehiscent jugular bulb)

Anatomical Considerations

It's important to distinguish between:

• Hemotympanum: Blood in the middle ear space
• Intra-tympanic membrane (iTM) hemorrhage: Bleeding confined within the layers of the tympanic membrane itself 1
• Otorrhea with blood: Bloody discharge from the ear canal, which may indicate tympanic membrane perforation

Diagnosis

Diagnosis is primarily made through:

• Otoscopic examination: Reveals a blue or purple discoloration of the tympanic membrane
• Pneumatic otoscopy: Shows decreased or absent mobility of the tympanic membrane
• Tympanometry: May show a flat (type B) tympanogram indicating middle ear effusion 2
• Imaging: CT scan may be used to rule out temporal bone fracture or vascular anomalies

Management

Management depends on the underlying cause:

1. Conservative approach (most cases):

   • Observation and monitoring
   • Reassurance that most cases resolve spontaneously within 1-4 weeks
   • Pain management if needed

2. For persistent cases:

   • Myringotomy (surgical incision in the tympanic membrane) with or without ventilation tube insertion may be considered for persistent effusion 3
   • Audiometric evaluation to assess hearing impact

3. For severe cases or specific etiologies:

   • Hemostatic agents for active bleeding during procedures
   • Surgical intervention for vascular anomalies or persistent bleeding

Special Considerations

Coagulopathies

Patients with coagulopathies require special attention:

• History of antiplatelet therapy, anticoagulation medications, hepatic/renal failure, thrombocytopenia, or hemophilia should be elicited
• These patients should be counseled about increased risk of ear bleeding 2

Surgical Complications

When hemotympanum occurs during ear surgery:

• Control bleeding with hemostatic agents (epinephrine-soaked cottonoids, cautery)
• Consider hydrogen peroxide washing
• For severe bleeding (e.g., jugular bulb injury), packing and possibly surgical repair may be needed 4, 5

Prognosis

• Most cases of hemotympanum resolve spontaneously without specific treatment
• Resolution typically occurs within 1-4 weeks
• Hearing typically returns to baseline once the blood is resorbed
• Persistent cases may require intervention to prevent long-term conductive hearing loss

Clinical Pearls

• Hemotympanum without other symptoms rarely requires immediate intervention
• Always rule out temporal bone fracture in traumatic cases
• Distinguish from other causes of blue tympanic membrane (e.g., cholesterol granuloma)
• In children with recurrent hemotympanum, consider tympanostomy tubes for ventilation and drainage 2