Digital otoscopic examination of tympanic membranes in confirmed suicidal hanging deaths: Preliminary autopsy study

A crucial factor in cases of apparent hanging deaths is establishing whether an antemortem hanging or postmortem suspension has occurred. Hanging diagnosis relies upon the history, scene investigation, and gross examination of the body including the ligature furrow and possible resultant injuries including hemorrhages, fractures, and petechiae. However, pathognomonic changes are lacking. Examination of the tympanic membrane may provide additional information to assist in distinguishing antemortem hanging from postmortem suspension. The changes in the tympanic membrane in cases of hanging deaths have not been extensively studied, with only a few case reports available on the subject. The common findings seen on otoscopy in hanging deaths are hemotympanum, petechial hemorrhages, and otorrhagia. In our study, we included 30 cases of confirmed suicidal hanging deaths and 15 non hanging cases as control. Among 30 cases of confirmed suicidal hanging deaths, bilateral hemotympanum was observed in 29 cases. Among these 29 cases of bilateral hemotympanum, one case showed bilateral otorrhagia along with bilateral hemotympanum, while another case showed unilateral right-sided otorrhagia with bilateral hemotympanum. None of the cases showed presence of petechial hemorrhage exclusively. These changes were independent of age, sex, type of hanging, type of ligature material, and position of the knot. None of the controls showed evidence of petechial hemorrhages, hemotympanum, or otorrhagia. Otoscopy can be employed as a simple, non-invasive method to study the changes in the tympanic membrane and may be an adjunct to determining vitality in hanging deaths.