title: Bilateral spontaneous hemotympanum: case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.
authors.affiliation: Department of Otolaryngology, Tzanion General Hospital, Piraeus, Greece. balats@panafonet.gr
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Balatsouras
authors.forename: Panayotis
authors.initials: P
authors.lastname: Dimitropoulos
authors.forename: Alexandros
authors.initials: A
authors.lastname: Fassolis
authors.forename: Georgios
authors.initials: G
authors.lastname: Kloutsos
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Economou
authors.forename: Stavros
authors.initials: S
authors.lastname: Korres
authors.forename: Antonis
authors.initials: A
authors.lastname: Kaberos
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D006312:Hearing Loss, Bilateral / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006320:Hearing Tests; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D014432:Tympanic Membrane
chemical_list: D000925:Anticoagulants