Bilateral spontaneous hemotympanum: Case report

A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating.Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels.Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head, especially when temporal bone fracture occurs [1,2]. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media [3,4]. In these cases it may be attributed to chronic middle ear effusions, such as granulation and cholesterol tissue originating from a cholesterol granuloma [5].The aim of this study is to present a rare case of spontaneous bilateral hemotympanum in a patient under medication with anticoagulants.A 72-year-old male presented in the emergency ward with acute deterioration of hearing, which occurred during the past 24 hours. In the patient's past medical history aortic valve replacement in May 2004, 1 year before presentation was reported. Since then he had been administered on a regular basis coumarinic anticoagulants. His INR (International Norma