Hemotimpanum

Haemotympanum is an accumulation of blood in the tympanic cavity (middle ear), i.e., directly behind the eardrum. During an ear examination (otoscopy), the eardrum appears bluish, purple or almost black due to the blood showing through it.

This condition is not an independent disease, but rather is an important clinical sign, most often indicating injury.

Aetiology and pathophysiology

The most common and serious cause of haemotympanum is a fracture of the skull base, in particular a fracture of the temporal bone pyramid. Blood from the cranial cavity leaks into the tympanic cavity.

Other possible causes include direct injury to the ear, barotrauma (sudden change in pressure), blood clotting disorders, or, in rare cases, tumours of the middle ear.

Clinical Significance

The detection of haemotympanum, especially after head injury, is a red flag and requires immediate attention. This is one of the classic symptoms of a skull base fracture, along with the “spectacle sign” and Battle’s sign.

Clinically, haemotympanum manifests as conductive hearing loss (decreased hearing) on the affected side and a feeling of fullness or blockage in the ear. The doctor makes the diagnosis during an otoscopy. If a skull base fracture is suspected, a computed tomography (CT) scan of the head is mandatory.

Treatment is aimed at the underlying cause. Blood from the middle ear usually resolves on its own within a few weeks.