Case report

Bilateral spontaneous hemotympanum: Case report

Dimitrios G Balatsouras¹ , Panayotis Dimitropoulos¹ , Alexandros Fassolis¹ , Georgios Kloutsos¹ , Nicolas C Economou¹ , Stavros Korres² and Antonis Kaberos¹

¹  Department of Otolaryngology, Tzanion General Hospital, 1 Afentouli & Zanni, Piraeus, Greece

²  Department of Otolaryngology, Athens National University, Hippokration Hospital, 114 Vas. Sofias Av., Athens, Greece

author email corresponding author email

Head & Face Medicine 2006, 2:31doi:10.1186/1746-160X-2-31

Published:	4 October 2006

Abstract

Background

The 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 presentation

A 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.

Conclusion

Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.