Differential Diagnosis for Woke Up Bleeding from Both Ears

• Single Most Likely Diagnosis
  • Trauma: This is the most likely diagnosis, as bleeding from both ears is often associated with head trauma, which could have occurred during sleep due to a fall or other accident. The trauma could cause a basilar skull fracture leading to bilateral ear bleeding.
• Other Likely Diagnoses
  • Infection: Severe infections such as otitis media or mastoiditis could potentially cause bleeding from the ears, although this would typically be accompanied by other symptoms like fever, pain, and discharge.
  • Barotrauma: Changes in atmospheric pressure, such as during air travel or deep-sea diving, can cause ear barotrauma, leading to bleeding. However, this would typically be associated with a history of recent travel or diving.
• Do Not Miss Diagnoses
  • Basilar Skull Fracture: Although mentioned under trauma, it's crucial to highlight this as a "do not miss" diagnosis due to its severity and potential for serious complications, including meningitis or cerebral spinal fluid leak.
  • Malignancy: Although rare, tumors in the ear or skull could cause bleeding. Missing a diagnosis of malignancy could have severe consequences, making it essential to consider, especially in the absence of trauma or infection.
• Rare Diagnoses
  • Vasculitis: Certain types of vasculitis, such as granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), can affect the ears and cause bleeding, though this would typically be part of a broader systemic illness.
  • Coagulopathy: Bleeding disorders or the use of anticoagulant medications could potentially lead to spontaneous ear bleeding, though this would be extremely rare and usually associated with other bleeding symptoms.
  • Eosinophilic Otitis Media: A rare condition characterized by an eosinophilic infiltration of the middle ear, which can cause bleeding among other symptoms, typically in the context of asthma or other atopic diseases.