Etiopathogenesis of So-Called Idiopathic Hemotympanum and Its Relation to Morphogenesis of the Adhesive Process: Chronic Postinflammatory Hematoma of the Pneumatic Cavities of the Ear

Abstract

SUMMARY.

The authors present a new theory about the origin, development and consequences of idiopathic hemotympanum, which they have worked out on the base of the analysis of three cases of their own, study of 23 cases from literature and various supplementary materials.

The origin of the disease is an acute hemorrhagic inflammation of all pneumatic cavities of the ear. If secondary suppurative infection of blood coagulations does not occur because of treatment with antibiotics, regular processes occur in the coagulum: (1) organizing processes producing typical histological findings; (2) autolytic processes producing a coffee-brown liquid by colliquation of the fibrinous component of the coagulum, again with typical microscopic findings.

Overpressure of liquids in the pneumatic cavities manifests itself by bulging of the eardrum. The overpressure is conditioned by the absorption of liquids from the neighbouring tissues in consequence of the great colloido-osmotic difference of two inner media: the hemotympanum liquid and the liquids of the neighbouring tissues. Also transudation from venostasis and inflammatory exudation from granular tissue may take part in these very active biophysical processes.

Patency of the eustachian tube has no influence on the development and duration of hemotympanum. Puncture of the tympanic cavity and paracentesis have no effect either, because the liquid removed is regenerated and newly supplied by the biophysical processes described.

Healing requires atticoantrotomy with revision of all pneumatic cavities of the ear. Cases in which the whole hematoma is colliquated can be healed. Cases in which the organizing factor is expressed tend to result in an adhesive process.

The authors propose a new term instead of the term used up to now, viz. chronic postflammatory hematoma of pneumatic cavities of the car, which corresponds to etiopathogenesis and localization of the disease.

Otolaryng. Dept., Medical Faculty, Charles University, Hradec Králové, Czechoslovakia