Otorrhagia, or bleeding from the ear, can originate from any point in the ear’s anatomy, from the external flap to the deep inner structures. Causes range widely from minor superficial injuries to serious medical emergencies. The source of the bleeding often dictates the necessary treatment and the level of urgency required.
Superficial Injuries and External Canal Irritation
Otorrhagia often involves damage to the skin lining the outer ear and the external auditory canal. This delicate skin is susceptible to small cuts and abrasions. Minor trauma often occurs due to attempts at cleaning, such as using cotton swabs or fingernails to remove earwax.
Inserting foreign objects too deeply can easily scratch the canal wall, resulting in a few drops of blood that typically stop quickly. A foreign object lodged within the canal can also cause chronic irritation, leading to localized bleeding and discomfort.
The skin may also be compromised by infections like otitis externa, commonly known as “Swimmer’s Ear.” This inflammation of the ear canal is usually caused by bacterial growth in a moist environment. The swelling can cause the superficial skin to crack or fissure, producing a blood-tinged discharge.
Ruptured Eardrum and Middle Ear Infections
Bleeding originating deeper within the ear often stems from damage to the tympanic membrane, or eardrum. A perforated eardrum, a tear in this thin membrane, can occur from trauma or pressure changes. Direct physical trauma, such as a sharp object puncturing the membrane, causes immediate bleeding and sharp pain.
Pressure trauma, known as barotrauma, is another mechanism for eardrum rupture. This occurs when the air pressure outside the ear changes rapidly compared to the pressure in the middle ear. Barotrauma is seen with activities like scuba diving, flying during rapid altitude changes, or a forceful slap over the ear. The sudden pressure differential tears the membrane, resulting in blood mixed with ear drainage.
Middle ear infections (otitis media) are a common cause of eardrum perforation, especially in children. These infections cause fluid and pus to build up in the middle ear cavity, creating pressure against the eardrum. If the pressure becomes too high, the membrane spontaneously ruptures, releasing the trapped fluid mixed with blood. This rupture is often noted by a sudden relief of pain followed by the bloody discharge.
Severe Trauma and Underlying Conditions
Otorrhagia can result from high-impact trauma extending into the surrounding bone. Severe blunt force to the head, such as from a car accident or significant fall, can cause a temporal bone or basilar skull fracture. Bleeding associated with these fractures often presents with a darker, more profuse flow.
A sign of a fracture involving the base of the skull is cerebrospinal fluid (CSF) mixed with the blood, known as CSF otorrhea. This clear, watery fluid indicates a tear in the protective lining of the brain, creating a pathway for infection. Other signs suggesting a basilar skull fracture include bruising around the eyes (“raccoon eyes”) or bruising behind the ear over the mastoid bone (Battle’s sign).
Less commonly, bleeding may manifest from an underlying pathology like a vascular tumor or a polyp growing within the ear canal or middle ear. These conditions can erode the surrounding bone or become highly vascularized, leading to spontaneous or persistent bleeding. Unexplained, recurrent bleeding warrants comprehensive imaging and specialist evaluation.
When Bleeding Requires Immediate Medical Care
Any instance of ear bleeding should prompt a medical evaluation, but certain symptoms require an immediate trip to the emergency room. Bleeding following any head trauma must be treated as an emergency until a skull fracture is ruled out. This is especially true if the bleeding is accompanied by clear, watery discharge, suggesting a CSF leak.
Immediate emergency care is also necessary if the bleeding is associated with neurological changes. These include confusion, dizziness, loss of consciousness, persistent vomiting, or severe headaches. These symptoms point toward a potential internal injury or significant pressure changes within the skull.
For minor bleeding resulting from a superficial scratch or a known mild infection, a scheduled appointment is appropriate. While waiting for medical assistance, remain calm and avoid placing anything into the ear canal. Gently clean the ear of external blood, and place a clean, light dressing over the ear to absorb drainage. Allow the blood or fluid to drain naturally, as trying to stop the flow could force contaminants deeper into the ear.