Blue ear drum and cholesterol granuloma.

The otoscopic view is that of a right ear. The short process of the malleus is at the center of the top of the photo. Extending immediately downward from this is the long process of the malleus. Inferior to the umbo a neomembrane is retracted against the promontory, which appears as a yellowish globular mass. There is a scar involving the posterior and inferior edge of the pars tensa. The entire tympanic membrane appears blue and has been described as "blue ear drum." This condition is to be distinguished from hemotympanum, which represents blood within the tympanum. In this case, the patient has cholesterol granuloma, which is frequently associated with otitis media. Disintegrating red blood cells in the serous fluid give the blue color to the tympanic membrane.

Initial treatment for blue ear drum is to perform a myringotomy and place a ventilating tube. Any profuse mucous otorrhea is treated with an ear drop of equal parts Vasocidin and gamma globulin. If otorrhea persists after weeks of persistent local treatment, a surgical toilette of the mastoid and middle ear can be accomplished to help resolve the process. Patience and persistent treatment are required to resolve this subacute type of otitis media.

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