From the Guidelines
Ear bleeds, or otorrhagia, are most commonly caused by external ear canal trauma, ear infections, barotrauma, skull fractures, and temporal bone fractures, and require prompt medical evaluation to determine the underlying cause and appropriate treatment. The etiology of ear bleeds can range from minor trauma to serious medical conditions, including blood disorders, tumors of the ear canal or middle ear, and severe cases of otitis media with perforation of the tympanic membrane 1. It is essential to note that what appears to be blood from the ear may actually be cerebrospinal fluid mixed with blood, indicating a serious skull base fracture, which requires immediate medical attention.
Some potential causes of ear bleeds include:
- External ear canal trauma from cotton swabs, fingernails, or foreign objects
- Ear infections that cause inflammation and rupture of blood vessels
- Barotrauma from pressure changes during flying or diving
- Skull fractures that extend to the ear canal
- Temporal bone fractures following head trauma
- Blood disorders, such as those caused by anticoagulation medications, which can increase the risk of recurrent epistaxis and large volume blood loss 1
- Tumors of the ear canal or middle ear
- Severe cases of otitis media with perforation of the tympanic membrane
Treatment of ear bleeds depends entirely on the underlying cause, ranging from simple cleaning and antibiotic drops for minor trauma to surgical intervention for tumors or severe trauma. Anyone experiencing ear bleeding should seek medical evaluation promptly, as proper diagnosis through physical examination, otoscopy, and possibly imaging studies is essential for appropriate management. Additionally, guidelines for first aid in cases of epistaxis, which may be applicable to ear bleeds, recommend seeking medical attention if bleeding does not stop after 15 minutes of continuous manual pressure or if signs of brain injury, obvious nasal deformity, or signs of facial fracture are present 1.
From the Research
Ear Bleeds Etiology
- The etiology of ear bleeds can be related to various conditions affecting the external and middle ear, as discussed in 2.
- Some common conditions that may cause ear bleeds include otitis externa (OE), acute otitis media, chronic suppurative otitis media (including cholesteatoma), tympanic membrane (TM) perforations, and pinna haematoma 2.
- Ear pain (otalgia) can also be a symptom of underlying conditions that may lead to ear bleeds, with primary otalgia being more common in children and secondary otalgia being more common in adults 3.
- The most common causes of primary otalgia include otitis media and otitis externa, which can be diagnosed through examination of the ear and may lead to ear bleeds if left untreated or if complications arise 3.
- Secondary otalgia, on the other hand, can have a more complex etiology, including temporomandibular joint syndrome and dental infections, which may not directly cause ear bleeds but can contribute to ear pain and discomfort 3.