From the Research
Haemotympanum typically causes a conductive hearing loss of approximately 20-30 decibels (dB). This hearing loss occurs when blood fills the middle ear cavity, preventing normal vibration of the tympanic membrane and ossicular chain. The blood acts as a physical barrier that dampens sound transmission through the middle ear. Management involves treating the underlying cause, which is often trauma, barotrauma, or bleeding disorders, as seen in a case report of a patient with spontaneous bilateral hemotympanum who was treated with anticoagulants 1. Most cases resolve spontaneously within 2-3 weeks as the blood is reabsorbed, with hearing gradually returning to baseline.
During this period, patients should avoid activities that increase pressure in the middle ear, such as flying, diving, or forceful nose blowing. Antibiotics are not routinely needed unless there's evidence of infection. If hearing loss persists beyond 4-6 weeks, further evaluation with audiometry and possibly imaging is warranted to rule out ossicular damage or other complications. Myringotomy (surgical drainage) is rarely needed but may be considered for persistent cases causing significant hearing impairment, as described in a practical guide for performing myringotomy 2.
Some cases of haemotympanum may be associated with underlying conditions such as chronic middle ear effusion or bleeding disorders, and management should be tailored to the individual patient's needs, as discussed in a study on spontaneous hemotympanum associated with chronic middle ear effusion 3. Additionally, patients undergoing hyperbaric oxygen therapy may be at risk of middle ear barotrauma, and prophylactic myringotomy or tympanostomy tube placement may be considered in certain cases 4.
In general, the approach to managing haemotympanum should prioritize treating the underlying cause and avoiding activities that increase pressure in the middle ear, with further evaluation and treatment as needed to prevent complications and promote optimal hearing outcomes, as seen in a study on thrombocytopenia in hospitalized patients 5. The goal of treatment should be to minimize morbidity, mortality, and impact on quality of life, and to promote a full recovery from the condition.