The blue eardrum—idiopathic hemotympanum

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IN 1929, Shambaugh1 reported three cases in a paper entitled The Blue Drum Membrane, and he therefore is credited with being the first physician to recognize this clinical entity.2 In 1941, O’Donnell3 introduced the term “idiopathic hemotympanum” as being a more specific term than “blue drum.” Idiopathic hemotympanum was considered an uncommon entity, but in the last 10 years its occurrence has been frequently reported, possibly the result of an increased interest in the disease. Others4 have attributed its increased recognition to the parallel increased frequency of serous otitis media.

Clinical picture

The presenting symptoms of a patient with idiopathic hemotympanum may be otalgia, aural discharge, or loss of hearing. Occasionally, fullness in the affected ear will be the presenting complaint.5 When the patient has pain, it is usually intermittent and is suggestive of closure of the eustachian tube.6

The physical examination may reveal only hearing loss on the affected side and the striking feature of a bluish-black tympanic membrane. The membrane may or may not bulge, or it may even appear retracted. Decreased mobility of the tympanic membrane will be noted with the pneumatic otoscope. Occasionally, dry blood may be present in the external canal, and when this is a recent occurrence a perforation may be noted in the tympanic membrane. The hearing loss will be of a conductive type unless sensorineural impairment coexists, which would then result in a mixed type of hearing impairment.5

The eustachian tube usually can be inflated easily, which does not change the color . . .



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