Balatsouras Dimitrios G, Dimitropoulos Panayotis, Fassolis Alexandros, Kloutsos Georgios, Economou Nicolas C, Korres Stavros, Kaberos Antonis
Department of Otolaryngology, Tzanion General Hospital, Piraeus, Greece.
Head Face Med. 2006 Oct 4;2:31. doi: 10.1186/1746-160X-2-31.
The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein.
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.
血鼓室最常见的病因是治疗性鼻腔填塞、鼻出血、血液系统疾病和头部钝器伤。当在慢性中耳炎患者中检测到血鼓室时，其特征为特发性。本文报告一例接受抗凝治疗的患者发生自发性双侧血鼓室的罕见病例。
一名72岁男性因听力急性减退就诊。据患者病史报告，就诊前1年进行了主动脉瓣置换术。此后他一直定期服用香豆素类抗凝剂，国际标准化比值（INR）维持在3.4至4.0之间。耳镜检查发现双侧血鼓室。听力图显示双侧对称的中度重度混合性听力损失，以传导性成分为主。鼓室图双侧平坦，声反射消失。计算机断层扫描显示双侧乳突和中耳有积液。治疗采用保守治疗，包括为期10天的抗生素、减充血剂疗程以及暂时中断抗凝治疗。3周后，鼓膜恢复正常，听力恢复到先前水平。
抗凝剂的使用应纳入血鼓室的鉴别诊断，因为其检测和适当治疗可能导致病情缓解。
