Pathogenesis and Pathology of the "Idiopathic" Blue Ear Drum

Paparella, Michael M.; Lim, David J.

doi:10.1001/archotol.1967.00760040251004

Cited by 72 publications

(19 citation statements)

References 18 publications

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“…Since Shambaugh first reported two cases with 'blue drum membrane' in 1929 [21], there have been many reports of idiopathic blue ear drum or idiopathic hemotympanum [5,7]. The pathogenesis is believed to be the result of negative pressure in the middle ear cavity caused by poor eustachian tube function in patients with poorly pneumatized mastoid cavity [4,5].…”

Section: Discussionmentioning

confidence: 99%

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Activities of matrix metalloproteinases and tissue inhibitor of metalloproteinase-2 in idiopathic hemotympanum and otitis media with effusion

Moon

Linthicum

Yang

et al. 2008

Acta Oto-Laryngologica

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One case showed tympanic membrane thinning in the OM group, but none in the control group. While MMP-2 was present in all effusions, the active form of MMP-2 was found only in mucous effusions. MMP-3 and MMP-7 activity was detected only in the mucous effusions. MMP-9 exhibited activity in all effusions, with the highest levels in mucous effusions. TIMP-2 levels were markedly elevated in serous effusions.

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Section: Discussionmentioning

confidence: 99%

“…Idiopathic hemotympanum (or blue ear drum) is caused by a recurrent hemorrhage in the middle ear or mastoid in the presence of eustachian tube obstruction [4,5]. Cholesterol granuloma develops when the extravasated blood is broken down to cholesterol or hemosiderin, which subsequently induces a foreign body reaction [6].…”

Section: Introductionmentioning

confidence: 99%

Activities of matrix metalloproteinases and tissue inhibitor of metalloproteinase-2 in idiopathic hemotympanum and otitis media with effusion

Moon

Linthicum

Yang

et al. 2008

Acta Oto-Laryngologica

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“…From one point of view, idiopathic haemotympanum is not a speci c disease but 'a phase of otitis media with effusion'. 1,2 However, certain differences are noted when the independent disease, CG, is compared with intractable otitis media with effusion. Comparing special features of CG with those of intractable infant otitis media with effusion, Nakano 3 states that the incidence of CG is highly unilateral, commonly found within the range of 10-19 years of age, affected subjects have eustachian tube dysfunction, are affected by blue eardrums and the symptoms are intractable.…”

Section: Discussionmentioning

confidence: 99%

Surgical intervention in middle-ear cholesterol granuloma

et al. 2003

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Eleven patients who had been surgically treated from 1988 to 1999 were retrospectively reviewed in order to evaluate the ef cacy of ventilation tube insertion and mastoidectomy with, or without, mastoid obliteration for intractable middle-ear cholesterol granuloma. The mean age registered was 17.2 years at the time of surgical treatment. All cases were unilaterally affected. Five ears were treated with simple mastoidectomy coupled with the insertion of a ventilation tube, while six others had additional mastoid obliteration. The hearing prognosis was excellent with an improved post-operative hearing level of 16.5.dB (cf. pre-operative 37.7.dB). However, morphological prognosis revealed two ears had a residual perforated tympanic membrane without otorrhoea after displacement of the ventilation tube. Of the remaining nine ears with intact placement of the ventilation tube, ve had dry ears while four had occasional otorrhoea. Although the morphological prognosis was incomplete, treatments involving at least an insertion of a ventilation tube with thorough mastoidectomy were thought to be necessary.Key words: Granuloma, Foreign-Body; Middle Ear Ventilation; Mastoid, surgery Introduction Cholesterol granuloma (CG) is a pathological term that describes a lesion often observed during operative procedures for chronic middle-ear diseases. In cases where partial blockade of the middleear cavity is found, mucosal vasculature-derived transudation and cholesterol precipitation are encountered in obstructed peripheral air spaces. As a result of the ensuing foreign body reaction to cholesterol crystals, a granuloma is formed. In other words, middle-ear lesions such as chronic otitis media, adhesive otitis media and middle-ear cholesteatoma, etc., are often accompanied by CG. The existence of major CG in the form of otitis media without other middle-ear diseases causing blockade, however, has reinforced the concept that middle-ear CG is an independent disease per se. As a single disease, CG is intractable and its aetiological/ therapeutical perspectives remain unresolved. As CG prevails within the mastoid cavity, surgical intervention has been resorted to as a reliable con rmatory diagnosis of the lesion, despite recent advances in imaging diagnoses. In this study, clinical investigations focusing on surgically con rmed cases of CG as an independent disease were attempted to evaluate the ef cacy of surgical treatments for intractable middle-ear CG.

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“…The clinical conditions of chronic serous mastoiditis, idiopathic hemotympanum (Paparella and Lim, 1967) and active chronic suppurative otitis media (Cody, 1977) all may represent phases in the pathologic condition related to chronic eustachian tube obstruction.…”

Section: Introductionmentioning

confidence: 99%

Mastoidectomy for chronic serous otitis media

Newberg¹

1981

J. Laryngol. Otol.

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THE purpose of this paper is to show that satisfactory results following mastoidectomy can be obtained for the problem of chronic serous otitis. The success of the simple mastoid operation or mastoidectomy with facial recess approach and the subsequent increased aeration of the mastoidantral-attic-middle-ear complex is to be suggested when the repeated use of myringotomy tubes alone is not the answer to chronic serous otitis. It is chronic negative pressure due to eustachian tube dysfunction that leads to irreversible mastoid disease.Seven cases of mastoidectomy for chronic serous otitis media are presented. All cases had adequate conservative medical and surgical treatment over a period of years for chronic serous otitis before mastoidectomy was considered. The clinical history, as well as lateral mastoid X-ray, was used in diagnosing irreversible mastoid disease. IntroductionThe standard treatment of chronic serous otitis media has not always proved satisfactory. The use of antibiotics, decongestants, allergic workup (including desensitization), politizeration techniques, aspirations, tubes and other modalities for the relief of chronic serous otitis based on eustachian tube obstruction has in some cases only prolonged the changes associated with chronic serous otitis. The possibility of intractable mastoid disease with its effects on the tympanic membrane and hearing has at times only been given cursory examination. The technique of mastoidectomy in the treatment of chronic serous otitis media is controversial but the articles of Austin (1977) and Sheehy et al (1969) suggest that the technique has merit.Mastoidectomy increases the volume of the mastoid bone and leads to physical changes in the transmission of sound which improve hearing. The following seven cases did not respond in the usual way to standard treatment and required mastoidectomy. Contributing factors such as deviated septum, chronic sinusitis and/or allergy in chronic eustachian tube dysfunction were present and adequately treated as soon as diagnosed including repeated tube insertions. The underlying mastoid disease related to chronic negative pressure in the middle-ear-atticantrum-mastoid complex was not altered permanently by the repeated use of ventilation tubes in these cases.

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Pathogenesis and Pathology of the "Idiopathic" Blue Ear Drum

Cited by 72 publications

References 18 publications

Activities of matrix metalloproteinases and tissue inhibitor of metalloproteinase-2 in idiopathic hemotympanum and otitis media with effusion

Activities of matrix metalloproteinases and tissue inhibitor of metalloproteinase-2 in idiopathic hemotympanum and otitis media with effusion

Surgical intervention in middle-ear cholesterol granuloma

Mastoidectomy for chronic serous otitis media

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