Ear Bleeding Differential Diagnosis
The following is a differential diagnosis for ear bleeding, categorized for clarity and importance.
Single most likely diagnosis
- Trauma: This is often the most common cause of ear bleeding, resulting from direct injury to the ear, such as a blow to the head, a fall, or insertion of objects into the ear canal. The mechanism of injury can cause lacerations or rupture of blood vessels within the ear.
Other Likely diagnoses
- Otitis externa: An infection of the outer ear canal, which can cause inflammation, pain, and sometimes bleeding due to the rupture of small blood vessels or the formation of an abscess.
- Otitis media with perforation: A middle ear infection that can lead to the rupture of the eardrum, resulting in bleeding and discharge.
- Eustachian tube dysfunction: Abnormalities in the Eustachian tube's function can lead to middle ear problems, including bleeding, though this is less common.
- Foreign body: The presence of a foreign object in the ear canal can cause irritation, infection, or direct trauma leading to bleeding.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Basilar skull fracture: A serious head injury that can cause bleeding from the ear due to a fracture in the base of the skull. This condition requires immediate medical attention.
- Malignancy (e.g., ear canal cancer): Though rare, cancers of the ear canal or middle ear can present with bleeding and should not be overlooked due to their potential severity and impact on prognosis.
- Vascular anomalies or malformations: Rare conditions that can cause bleeding due to abnormal blood vessel formation or function within the ear.
Rare diagnoses
- Hematological disorders (e.g., leukemia, coagulopathy): Conditions that affect blood clotting or cell production can lead to spontaneous bleeding, including from the ear, though this would be an uncommon presentation.
- Infections like mastoiditis: An infection of the mastoid bone in the skull, which can lead to complications including bleeding, though this is less common and usually follows otitis media.
- Relapsing polychondritis: A rare autoimmune disorder that can cause inflammation and damage to cartilaginous structures, including those in the ear, potentially leading to bleeding.