What is the cause of left ear pain, hemotympanum (blood coming from the ear), and referred pain to the tragus, accompanied by a headache and left-sided head and jaw pain, without signs of otitis externa (outer ear infection) or otitis media (middle ear infection)?

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Last updated: March 28, 2025 • View editorial policy

Differential Diagnosis for Left Ear Pain with Blood and Associated Symptoms

  • Single most likely diagnosis + Temporomandibular joint (TMJ) disorder: This condition can cause ear pain, jaw pain, and headache. The pain to the tragus (the small flap of cartilage in front of the ear canal) and the absence of signs of otitis externa or media make TMJ disorder a plausible explanation, as it can refer pain to the ear area.
  • Other Likely diagnoses + Dental issues (e.g., abscess, impaction): Dental problems can cause referred pain to the ear, especially if the issue is with the molars, and can also lead to headache and jaw pain. + Parotid gland pathology (e.g., parotitis, tumor): The parotid gland is located near the ear, and conditions affecting it can cause ear pain, facial pain, and potentially bloody discharge if there's an infection or tumor. + Mastoiditis: Although there are no signs of otitis media, mastoiditis (an infection of the mastoid bone) can present with ear pain, headache, and could potentially cause bloody discharge if the infection erodes through the bone or into the ear canal.
  • Do Not Miss diagnoses + Malignancy (e.g., nasopharyngeal carcinoma, parotid gland tumor): Although rare, these conditions can present with ear pain, bloody discharge, and other symptoms like headache and jaw pain. Missing these diagnoses could be fatal. + Middle ear trauma or perforation: Even without signs of otitis media, a perforated eardrum could cause bloody discharge and ear pain. This is especially critical if the trauma was recent and could indicate a more serious injury. + Temporal arteritis: This condition, characterized by inflammation of the blood vessels in the head, can cause headache, jaw claudication, and potentially ear pain. It's a medical emergency due to the risk of vision loss.
  • Rare diagnoses + Ramsay Hunt syndrome (herpes zoster oticus): This condition, caused by the varicella-zoster virus, can lead to ear pain, facial weakness, and sometimes bloody discharge from the ear, along with other symptoms like headache. + Eosinophilic otitis media: A rare condition characterized by an eosinophilic infiltration of the middle ear, which can cause ear pain, discharge (potentially bloody), and other symptoms, often in the context of asthma or other atopic diseases. + Cholesteatoma: An abnormal skin growth in the middle ear behind the eardrum, which can cause ear pain, discharge (sometimes bloody), and other complications if not treated.

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