The Control of Hemorrhage in Otolaryngology
Hemorrhage from any part of the body is distressing and terrifying to the patient. In the field of otolaryngology this is particularly true, for the patient has not only the fear of bleeding to death but also the fear of suffocation from the accumulated blood. This fear arises because the bleeding most often fills the air passages, interfering materially with breathing.
Severe hemorrhage from the ear is rare but can occur. It may follow trauma which has ruptured the ear drum or caused a skull fracture through the temporal bone. These hemorrhages are usually not severe and should be left alone. Ear drops should never be used in such cases unless infection ensues. If there is no infection the use of irrigation or the instillation of drops may set up a serious infection.
Blood may collect in the tympanum behind an intact drum following neurosurgical procedures in which the cranium is opened close to the mastoid and some of the mastoid cells exposed. Blood may also reach the tympanum during a severe nasal hemorrhage, the blood flowing up the eustachian tube. In both these situations one usually treats the condition expectantly.
In the former an attempt to evacuate the blood by myringotomy and inflation might lead to intracranial infection, and in the latter one can do no intranasal manipulation other than that required to stop the nasal hemorrhage.
Severe hemorrhage can occur in the following instances:
After myringotomy in a patient with a high jugular bulb extending into the. . .