Traumatic hemotympanum with facial palsy.A 55-year-old man sustained a minor head injury when he fell from a motorcycle. He was unconscious for 2 minutes. Afterward he noticed a slight hearing loss on the right side. Four days later, he developed facial weakness on the right side. Otoscopic examination revealed that the right tympanic membrane was intact but that it was dark blue and almost black, indicating the presence of blood in the tympanum tympanum (tĭm`pənəm). In architecture, the triangular space of a pediment, or low-pitched gable, above a portico, door, or window. Its boundaries are generally cornice moldings. (figure, A). Neurologic examination revealed that the patient had right lower motor neuron lower motor neuron n. A motor neuron whose cell body is located in the brainstem or the spinal cord and whose axon innervates skeletal muscle fibers. Also called final motor neuron. facial nerve palsy facial nerve palsy Facial palsy, see there , assessed as grade III on the House-Brackmann scale. The patient was diagnosed with traumatic hemotympanum with delayed post-traumatic lower motor neuron facial palsy. He was treated conservatively with oral steroids and amoxicillin/clavulanic acid. After 3 weeks, his facial palsy and hemotympanum had resolved (figure, B), and his hearing had improved. [FIGURE OMITTED] Traumatic hemotympanum causes the tympanic membrane to appear dark blue, purplish, or even almost black. It has traditionally been said to be pathognomonic pathognomonic /pa·thog·no·mon·ic/ (path?ug-no-mon´ik) specifically distinctive or characteristic of a disease or pathologic condition; denoting a sign or symptom on which a diagnosis can be made. of a temporal bone fracture. (1,2) Hemotympanum can also occur (1) as a result of the forcing of blood into the middle ear during hemoptysis Hemoptysis Definition Hemoptysis is the coughing up of blood or bloody sputum from the lungs or airway. It may be either self-limiting or recurrent. Massive hemoptysis is defined as 200-600 mL of blood coughed up within a period of 24 hours or less. associated with advanced tuberculosis, (2) as a result of spontaneous hemorrhage into the temporal bone in patients who have leukemia or who are on anticoagulant drug therapy, and (3) as a result of retrograde hemorrhage following epistaxis. (3) But by far, the most common cause of hemotympanum is trauma to the head. Without a supportive history, a blue eardrum in the presence of a cholesterol granuloma can make the differential diagnosis difficult. Reports in the literature suggest that traumatic hemotympanum may be treated conservatively. (1,2) Prophylactic antibiotics are given until resolution, which usually occurs within 4 weeks. No cases of myringotomy as a therapeutic technique in traumatic hemotympanum have been reported. High-resolution computed tomography high-resolution computed tomography Imaging CT at slice–collimation scan interval widths of ≤ 4 mm, which is narrower than the usual 1-3 cm interval 'slices' obtained in conventional CT imaging. Cf Spiral computed tomography. of the temporal petrous petrous /pet·rous/ (pet´rus) resembling a rock; hard; stony. pet·rous adj. 1. Of stony hardness. 2. bones should be obtained to look for potential basal skull fracture basal skull fracture Orthopedics A fracture involving the base of the cranium Clinical May be asymptomatic; raccoon eyes, Battle sign, hemotympanum, CSF rhinorrhea Imaging Plain skull film may not reveal fracture; CT or MRI is more reliable. See LeFort fracture. . References (1.) Pulec JL, Deguine C. Hemotympanum from trauma. Ear Nose Throat J 2001;80:486. (2.) Deguine C, Pulec JL. Temporal bone fracture with hemotympanum. Ear Nose Throat J 2003;82:903. (3.) Evans TC, Hecker J, Zaiser DK. Hemotympanums secondary to spontaneous epistaxis. J Emerg Med 1988;6:387-9. Sampan Singh Bist, MS; Manisha Bisht, MBBS; Saurabh Varshney, MS From the Department of ENT, Himalayan Institute of Medical Sciences, Dehradun, Uttaranchal, India. |
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