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Hematotympanum in Adult
Other Resources UpToDate PubMed

Hematotympanum in Adult

Contributors: Erica J. Ross BA/BM, Paul C. Bryson MD, MBA
Other Resources UpToDate PubMed


Hematotympanum, or hemotympanum, refers to the presence of blood in the tympanic cavity of the middle ear. It can also be used to describe an ecchymosis of the tympanic membrane. This condition is characterized by blue-black discoloration of the tympanic membrane. Furthermore, the buildup of blood behind the membrane can cause bulging of the membrane. This condition causes conductive hearing loss and sometimes presents with facial nerve palsy or otorrhea in the context of other injuries.

There are many possible causes of hematotympanum. The most common causes typically involve trauma. Hemotympanum can be seen from cotton swab (eg, Q-tip) injuries and in the context of more severe head trauma where a temporal bone fracture is present. Barotrauma from diving or from flying are also common causes.

Another cause of hemotympanum is epistaxis, which can lead to eustachian tube dysfunction and retrograde blood flow into the middle ear cavity. Therapeutic nasal packing and surgical procedures such as septoplasty can also lead to retrograde flow of blood into the inner ear. Abnormalities of coagulation can lead to bilateral hemotympanum. This can be seen in the context of oral anticoagulation medications, conditions that affect the hematologic system such as leukemia and lymphoma, or chemotherapeutic medications.

A paraganglioma, a vascular tumor of the middle ear, can mimic the appearance of hemotympanum. Abnormalities of the carotid artery, including aneurysm or aberrant course through the petrous portion of the temporal bone, can also mimic the appearance of blood in the middle ear.

Given the variability of causes, this condition can affect people of all demographics and locations.


H74.8X9 – Other specified disorders of middle ear and mastoid, unspecified ear

111536009 – Hematotympanum

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The diagnosis of hematotympanum is straightforward through otoscopic exam. However, determining the causes of hematotympanum can be determined via history, imaging, and lab tests.
  • Otitis media – characterized by fever, ear pain, possibly otorrhea
  • Epistaxis, therapeutic nasal packing, and septoplasty – can be revealed through a thorough history
  • Hematologic conditions – abnormal complete blood count (CBC); elevated prothrombin time (PT) and partial thromboplastin time (PTT)
  • Anticoagulant medications – can be revealed through a thorough history; elevated PT and PTT
  • Cancer chemotherapy – can be revealed through a thorough history
  • Paraganglioma – seen via magnetic resonance imaging
  • Abnormalities of the carotid artery – seen via computed tomography scan with intravenous contrast
  • Temporal bone fracture and skull base fracture – trauma will be revealed through a thorough history and CT can confirm presence of fractures
  • Strangulation and barotrauma – can be revealed through a thorough history

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:03/24/2022
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Hematotympanum in Adult
A medical illustration showing key findings of Hematotympanum : Hearing loss, Otalgia, Otorrhea
Copyright © 2022 VisualDx®. All rights reserved.