How to manage epistaxis (nose bleed) of the ear?

Management of Ear Bleeding

For bleeding from the ear itself (not nosebleed), immediate assessment is needed to determine if this is external ear trauma with hematoma formation or bleeding from the ear canal, as management differs fundamentally from epistaxis.

Critical Initial Assessment

The question asks about "ear bleed," which requires clarification of the bleeding source:

• External ear trauma with hematoma: Requires prompt drainage within 24-48 hours to prevent cartilage necrosis and cauliflower ear deformity 1
• Ear canal bleeding during surgery: Managed with hemostatic agents including diluted epinephrine injection (1:200,000), cottonoids soaked with epinephrine (1:1000), mono- or bipolar cautery, hydrogen peroxide washing, and self-suctioning instruments 2
• Auricular hematoma: Needs immediate drainage and prevention of reaccumulation to avoid perichondritis, infection, and necrosis 1

Management of Auricular Hematoma (Most Common "Ear Bleed")

If the bleeding has resulted in hematoma formation between the cartilage and perichondrium, immediate drainage is essential to preserve cartilage viability.

Immediate Intervention

• Drain the hematoma promptly using needle aspiration or incision and drainage 1
• Apply pressure dressing after drainage to prevent reaccumulation 1
• The ear cartilage receives nutrients from the overlying perichondrium, so blood collection disrupts this supply 1

Prevention of Complications

• Untreated hematomas lead to: perichondritis, infection, cartilage necrosis, and permanent cauliflower ear deformity 1
• Long-standing hematomas cause loss of blood supply and formation of neocartilage from disrupted perichondrium 1

Management of Intraoperative Ear Canal Bleeding

For bleeding during endoscopic ear procedures:

• Injection of diluted epinephrine (1:200,000 with 2% mepivacaine) provides effective hemostasis 2
• Cottonoids soaked with epinephrine (1:1000) for topical application 2
• Bipolar or monopolar cautery for vessel coagulation 2
• Hydrogen peroxide washing to clear blood and visualize bleeding source 2
• Most bleeding occurs in the posterior superior external auditory canal 2

When to Seek Specialist Care

• Immediate ENT consultation if bleeding persists despite initial measures 2
• Auricular hematomas require urgent drainage within 24-48 hours to prevent permanent deformity 1
• Cauliflower ear management requires excision of deformed cartilage and auricular reshaping by a specialist 1

Common Pitfalls to Avoid

• Delaying hematoma drainage: Waiting beyond 24-48 hours significantly increases risk of permanent cartilage damage and cauliflower ear 1
• Inadequate pressure dressing: After drainage, failure to apply proper compression allows hematoma reaccumulation 1
• Confusing ear bleeding with epistaxis: These require completely different management approaches 3, 1