【Objective】To evaluate the diagnosis and therapy of several uncommon middle ear diseases which manifested with blue tympanic membrane. 【Methods】Retrospectively analyze the clinical characters and treatments of twenty-one cases which manifested with blue tympanic membrane. 【Results】Among the twenty-one cases with blue tympanic membrane

eight were diagnosed of middle ear cholesterol granuloma

three were haemotympanum by trauma

one was tympanic type of tumor of glomus jugular

two were tumor of glomus jugular

four were exalted jugular vein

two were chronic secretory otitis media

and one was capillary angioma in the tympanic cavity. Surgical treatment to eliminate the diseased tissue and drainage for tympanic cavity

antrum and mastoid cells had gotten good results in most cases.【Conclusion】Within the cases manifested with blue tympanic membrane

middle ear cholesterol granuloma was the commonest disease

followed by haemotympanum

chronic secretory otitis media

tumor of glomus jugular

exalted jugular vein

et al. History

auditory test and computed tomography (CT and MR) are needed for differentiated diagnose the above diseases. Surgical exploration and pathological examination are the golden criteria for final diagnosis.