Seeing blood drain from the ear, a symptom known as otorrhagia, is an alarming experience that should always be evaluated by a medical professional. The ear is an intricate structure divided into the outer, middle, and inner ear. Blood can originate from any of these areas, ranging from a minor scratch in the external canal to a serious injury to the skull base. A medical examination is necessary to pinpoint the source and determine the appropriate treatment path.
Superficial Causes and Ear Canal Irritation
The most common reasons for blood in the ear are often the least severe, originating from the delicate skin lining the external ear canal. This area is easily damaged by foreign objects or excessive cleaning. Even micro-abrasions caused by using cotton swabs or fingernails can result in noticeable bleeding that mixes with earwax. Because the thin skin in the deeper ear canal is well-supplied with blood vessels, even a small tear can bleed significantly.
Minor infections of the outer ear, known as otitis externa or “swimmer’s ear,” can also lead to inflammation and minor bleeding. This condition causes the skin of the ear canal to become swollen and irritated, potentially causing small blood vessels to rupture. Certain skin conditions, including eczema or psoriasis, can affect the ear canal, causing dryness, itching, and subsequent bleeding if the area is scratched. In these superficial cases, the bleeding is usually minor and self-limiting, though infection can introduce pain and discharge.
Middle Ear Issues and Eardrum Perforation
Bleeding that originates from beyond the ear canal often involves the tympanic membrane, or eardrum, which separates the external and middle ear spaces. A tear or hole in this thin membrane is called a perforation, and it is a common cause of blood draining from the ear. Perforation occurs because of a sudden buildup of pressure or direct trauma to the eardrum.
Acute middle ear infections (otitis media) are a frequent cause of eardrum rupture, particularly in children. The infection causes fluid and pus to accumulate in the middle ear, and the resulting pressure buildup forces the eardrum to tear. When the membrane ruptures, the accumulated fluid, which may be mixed with blood, drains out, often leading to immediate relief of severe ear pain.
Pressure changes, a phenomenon called barotrauma, can also cause the eardrum to tear and bleed. Rapid changes in air pressure during activities like flying, deep-sea scuba diving, or a hard blow to the ear create an imbalance that stretches and ruptures the membrane. Acoustic trauma from an extremely loud noise, such as an explosion, can also generate a shockwave strong enough to perforate the eardrum, causing immediate pain, hearing loss, and bleeding.
Severe Trauma and Rare Conditions
The most serious causes of otorrhagia are linked to major head trauma involving the base of the skull. A basilar skull fracture, a break in one of the bones at the base of the cranium, often involves the temporal bone near the ear. Bleeding from the ear in this context is a significant finding and may be mixed with cerebrospinal fluid (CSF), which indicates a tear in the membrane lining the brain.
The presence of CSF mixed with blood is a serious medical emergency because it creates a direct pathway for infection to reach the brain. Other signs of a basilar skull fracture include bruising behind the ear (Battle’s sign) or bruising around the eyes (“raccoon eyes”), though these symptoms may take a day or more to appear. Less commonly, bleeding can be a symptom of a tumor growing in the ear structures, such as a highly vascular glomus tumor. These rare growths can cause symptoms like pulsatile tinnitus and bleeding if they erode through the eardrum.
Immediate Steps and Medical Triage
If you notice blood coming from your ear, remain calm and assess the surrounding circumstances and any accompanying symptoms. A healthcare provider should evaluate any bleeding that is not clearly from a minor, external scratch. Avoid inserting anything into the ear canal, including cotton swabs or gauze, as this could cause further injury.
If the bleeding is minor and from a visible external cut, gently clean the outer ear and apply light pressure to the injury. Immediate emergency medical attention is necessary if the bleeding results from head trauma or is accompanied by urgent “red flag” symptoms. These symptoms include:
- Severe headache
- Sudden or significant hearing loss
- Vertigo or dizziness
- Confusion
- Loss of consciousness
For a potential eardrum perforation, place a sterile cotton ball loosely at the entrance of the ear canal to absorb drainage, and position the person with the affected ear tilted downward to allow fluid to drain naturally.