Haemotympanum is blood in the middle ear space. It is visible against the eardrum when looking down the ear canal. An otoscope needs to be used in order to carry out this examination. A doctor is able to diagnose the condition by seeing red blood through the thin membrane of the eardrum.
The commonest cause is probably nose-bleeding with packing of the nose. The space behind your nose communicates with the middle ear space through the Eustachian tube. If blood and pressure builds up in the nasal cavity then blood can flow up through the Eustachian tube into the middle ear space. It is then visible behind the eardrum.
Bleeding disorders such as haemophilia and drugs such as warfarin can also lead to haemotympanum. Haematological disorders such as leukaemia can also make bleeding more likely.
There is an association between secretory otitis media and haemotympanum. It has been suggested that these are both parts of the same pathological process.
Sometimes the mass behind the ear may look blue. The specialist doctor may investigate using a CT scan. This is to look for disorders of the blood vessels or bone damage from chronic infection or a tumour. An MRI scan may also be performed. This is useful for telling apart blood and vascular tumours.
Fracture of the temporal bone can also cause haemotympanum. The ear canal runs through this bone and so fracture may lead to blood in the canal. Fracture is caused by a blow to the head. There are likely to be other signs of a head injury as well. There will be a history of trauma and the patient may tell you they had a blow to the head. They may complain of a headache, nausea, vomiting, visual disturbances and other injuries. Drowsiness is common in skull fracture. If there is bleeding in the brain as well as the fracture there may also be reduced level of consciousness, coma, seizures and even death.
Please do not use this as medical advice. Consult a doctor if you have any disorder of the ear, skull or brain.
Dr Toby Bateson, MD of ZenPlugs