Temporal bone fracture with hemotympanum - Otoscopic Clinic - Brief Article

Ear, Nose & Throat Journal, Dec, 2003 by Christian Deguine, Jack L. Pulec

This otoscopic view is of a right ear with two pathologic entities. Anterior to the malleus at the top of the photograph is a groove in the bone of the external auditory canal that represents a fracture. The tympanic membrane is intact, but it has a dark blue, almost black, color, indicating that it is filled with blood. When associated with a history of trauma, hemotympanum is pathognomonic of a temporal bone fracture.

Hemotympanum by itself must be distinguished from hemorrhage into the ear caused by leukemia, the administration of anticoagulants, or hemoptysis in cases of advanced tuberculosis. The differential diagnosis includes blue eardrum and cholesterol granuloma.

The treatment of hemotympanum itself is conservative. Prophylactic antibiotics are often given to prevent infection. The blood usually resolves spontaneously within 4 weeks. If serous otitis persists longer than 1 month, myringotomy and insertion of a ventilating tube for a few weeks may be necessary. Fracture of the temporal bone detected by otoscopy or imaging requires no treatment unless there are other symptoms of facial palsy, conductive hearing loss, perilymphatic fistula, cerebrospinal fluid otorhinorrhea, vertigo, or tinnitus.

From Gap, France (Dr. Deguine), and the Pulec Ear Clinic, Los Angeles, (Dr. Pulec).