2012 Volume 105 Issue 3 Pages 211-215
A 25-year-old man experiencing abruptly increased right-ear pressure when jumping into a swimming pool was referred for pain and continuous bleeding. Daily antibiotics failed to stop bleeding necessitating tympanoplasty and mastoidectomy on day 4 after consultation. Extensive bleeding was found throughout the mastoid and tympanic cavities with edematous tympanic mucosa. The incus was removed and used as a columella. Purulent discharge and swelling prevented revision tympanoplasty untill 19 days after initial surgery. Infected mastoid and tympanic mucosa was removed. The postoperative course was uneventful, resulting in a dry, healthy ear drum.
Acute extensive bleeding within the mastoid cavity is rare. In our case, sudden pressure increase in the middle ear and mastoid cavity probably disrupted middle ear and the mastoid mucosa blood capillaries. This pressure change was most likely due to abrupt increase pressure in the ear canal and nasopharyngeal space due to glottal closure when the man hit the water. Increased intracranial pressure may also have caused the bleeding.
