Abstract
The cause of so-called “idiopathic hemotympanum” is still a matter of speculation, and no case has ever been reported in Japan.
The 4 cases reported here illustrate the results of clinical examinations and treatment of this disease.
1) The patients, three young men and a girl, suffered from repeated attacks of otalgia, bloody otorrhea and deafness.
One of them was bilaterally affected, while the others were unilaterally affected.
2) These attacks usually followed common colds and in most cases were improved within several weeks, although there was a stubborn tendency towards relapse.
3) The pars tensa of the affected eardrums appeared blackish-blue. In some cases, the pars flaccida was hyperemic and swollen.
4) The discharge from the middle ear cavities was a bloody chocolate-coloured exudation and sterile.
5) Hemorrhagic diathesis and tubal stenosis were not observed. 6) In X-ray examinations the affected ears showed sclerotic or poor pneumatisated mastoid processes, while the unaffected ears exhibited good pneumatisations.
7) The deafness was mainly due to conductive impairments. In some cases, however, hearing losses at high frequencies were greater than at low or middle frequencies.
8) Characteristically, all patients had contracted chronic tonsillitis.
9) Paracentesis and tubal inflation were effective only for short periods.
Three causes of “idiopathic hemotympanum” are conceivable, namely hemorrhagic diathesis, reduced pressure owing to tubal stenosis and inflammation. But the former two must be renounced.
The patients did not accept the operative treatments, and the pathogenesis of this disease has not yet been exactly clarified.
However, judging from the participation of the common colds in such attacks and the poor pneumatisated mastoid processes as are found in chronic otitis media, it is most conceivable that “idiopathic hemotympanum” is an inflammatory disease.
