Bleeding from the ear, medically termed otorrhagia, can be a startling symptom that ranges widely in cause and severity. The ear is divided into the outer, middle, and inner sections, and bleeding can originate from any of these areas. Understanding the source of the bleeding helps determine the necessary level of medical attention, as many causes are minor, but some indicate severe internal injury.
Minor and Localized Sources of Bleeding
The most frequent causes of ear bleeding involve superficial damage to the delicate skin lining the external ear canal. This lining is thin and sensitive, making it susceptible to minor trauma from everyday activities. Aggressive attempts to clean the ear with cotton swabs or fingernails can easily create small scrapes or lacerations that cause minimal bleeding. A foreign object, such as a misplaced earbud or a small item children sometimes insert, can also irritate the tissue enough to cause light oozing of blood.
Bleeding can also be a symptom of an outer ear infection, known as otitis externa. This condition causes the ear canal skin to become inflamed, swollen, and sensitive, and the irritated tissue may bleed slightly. The blood loss from these localized sources is generally minimal, often appearing as a streak or a few drops, and typically stops quickly. Though usually not serious, any break in the skin can introduce bacteria, making it important to keep the area clean to prevent a secondary infection.
Traumatic and Internal Causes of Otorrhagia
Bleeding originating beyond the ear canal often signals a significant injury to the middle or inner ear structures. Rupture of the tympanic membrane (eardrum) is a common cause of bleeding. This perforation can result from sudden, intense pressure changes, known as barotrauma, which occurs during activities like scuba diving or flying with severe congestion. Acoustic trauma from a loud explosion or a direct blow to the head can also tear the eardrum, leading to bleeding, pain, and a sudden decrease in hearing.
A severe middle ear infection (otitis media) can also cause eardrum perforation when pus and fluid build up, exerting pressure until the membrane tears. When the eardrum ruptures due to infection, the discharge often contains a mixture of blood and other fluids.
The most serious source of bleeding is trauma to the head, which can result in a fracture of the temporal bone, the part of the skull housing the ear structures. Temporal bone fractures cause bleeding from the ear canal due to lacerations of the skin or middle ear lining.
Severe trauma-related bleeding may be accompanied by the leakage of cerebrospinal fluid (CSF), a clear or yellowish fluid that bathes the brain and spinal cord. The presence of CSF mixed with blood, sometimes appearing as a “halo sign” when dripped onto a cloth, strongly indicates a basilar skull fracture. Such internal damage can also injure the inner ear structures, potentially causing dizziness, severe vertigo, or facial nerve paralysis, which requires immediate medical intervention.
When Ear Bleeding Signals an Emergency
Ear bleeding following any significant head trauma, such as a fall, accident, or direct blow, immediately signals a need for emergency medical care. Heavy, continuous bleeding, or bleeding that does not stop after a few minutes of light external pressure, also constitutes an emergency.
Do not attempt to clean the ear canal or insert any objects, including cotton swabs, to stop the flow of blood or fluid. Instead, gently cover the outer ear with a clean, sterile dressing or cloth, applying only light pressure externally.
Additional symptoms combined with bleeding—such as a sudden loss of consciousness, severe dizziness, persistent vomiting, or new-onset facial weakness—are signs of a potentially life-threatening internal injury. Any discharge that looks clear, watery, or thin and pink, suggesting the presence of cerebrospinal fluid, requires an immediate call to emergency services.