Abstract
BackgroundThe most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein.Case presentationA 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating.Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels.ConclusionAnticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.
Highlights
The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head
Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder
Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media [3,4]
Summary
The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head, especially when temporal bone fracture occurs [1,2]. The patient's history was clear from chronic middle ear problems or any underlying systemic disorder associated with defective hemostasis and from recent activities related with barotrauma, such as diving, air travel or Valsalva maneuvers He did not report systemic use of salicylates or any other drugs which could possibly interfere with coagulation, other than the coumarinic anticoagulants. In our patient regular uptake of anticoagulants was most probably the cause of spontaneous bilateral hemotympanum To our knowledge such a case has never been reported in the literature so far. Myringotomy and insertion of a ventilation tube is indicated for treatment when the condition persists after one month [1] In these cases, the presence of a glomus tumor, either involving the jugular bulb (glomus jugulare) or confined to the middle ear or mastoid (glomus tympanicum), should be considered [15]. Resolution was observed after 3 weeks, so that adjunctive therapeutic measures were not necessary
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