Hemotympanum from trauma.

The dark blue, almost black, color of the intact right tympanic membrane shown here indicates that the tympanum is filled with blood. Blood can be forced into the middle ear during hemoptysis associated with advanced tuberculosis, and it can occur as a result of spontaneous hemorrhage into the temporal bone in patients who have leukemia or who are on anticoagulants. Without a supportive history, a blue eardrum and cholesterol granuloma can make the differential diagnosis difficult. By far, the dominant cause of hemotympanum is trauma to the head. In this case, the patient, an 8-year-old boy, had been accidentally dropped on his head while playing with his father. In most cases, when associated with a history of trauma, hemotympanum is pathognomonic of a temporal bone fracture. Either a conductive or a sensorineural hearing loss, with or without vestibular involvement, might be present. Treatment is conservative. Prophylactic antibiotics are given until resolution, which usually occurs within 4 weeks. Myringo tomy and insertion of a ventilating tube is indicated for treatment of any serous otitis media that persists after 1 month.