The presence of dried blood in the ear canal is a common symptom that can appear as dark red or brown crusty residue, often mixed with yellowish-brown earwax. This discoloration occurs because the small amount of blood has been exposed to air, causing it to coagulate and oxidize before exiting the ear. While this symptom is frequently the result of a minor, superficial scratch, it can also signify a more substantial injury or issue deeper within the ear structure. Understanding the source of the bleeding, whether it is external to the eardrum or originates from the middle ear, is the first step in determining if medical attention is necessary.
Minor Causes Originating in the Outer Ear
The most frequent source of dried blood traces comes from the external auditory canal, the tube that runs from the visible outer ear to the eardrum. The skin lining this canal is thin and sensitive, making it vulnerable to minor trauma. One of the most common mechanisms of injury is the misuse of cotton swabs or other foreign objects inserted to clean the ear, which can easily cause a small abrasion or laceration on the canal wall.
The use of a fingernail to scratch an itch or the insertion of hearing aids or earplugs can also irritate the delicate skin. This minor trauma causes a capillary break, and the resulting slow bleed is often incorporated into the natural outward migration of cerumen, or earwax. When the blood mixes with the cerumen and dries, it leaves behind the characteristic dark, crusty appearance.
Certain dermatological conditions can also weaken the ear canal skin, making it prone to bleeding without direct trauma. Eczema or seborrheic dermatitis, for example, can cause the skin inside the ear to become excessively dry, flaky, or inflamed. When this dry skin cracks or is rubbed, it can result in minor fissuring and a subsequent light bleed. Even a small foreign body, such as a tiny insect or piece of debris, can scratch the canal as it attempts to exit or is being removed.
Bleeding Linked to the Middle Ear or Eardrum
A more concerning cause of dried blood involves injury to the tympanic membrane (eardrum), which separates the outer ear from the middle ear cavity. The eardrum is supplied with small blood vessels. A perforation, or tear, in this membrane will cause bleeding that then drains into the ear canal.
One significant cause of perforation is acute otitis media, a severe middle ear infection. During this infection, fluid and pus accumulate behind the eardrum, creating immense pressure. This pressure can cause tissue damage and eventually the rupture of the stretched membrane. The resulting bloody or pus-like discharge, known as otorrhea, flows into the ear canal, where it may dry and crust.
Bleeding from the eardrum can also be a direct result of rapid pressure changes, an event known as barotrauma. This commonly occurs during activities like scuba diving or flying when the Eustachian tube fails to equalize the pressure. The resulting pressure differential can stretch the eardrum, causing blood vessels to rupture, leading to bleeding or a full-thickness tear. The traumatic insertion of an object deep into the canal can also mechanically pierce the eardrum, causing immediate, sharp pain followed by light bleeding.
A forceful concussive injury, such as a severe blow to the side of the head or acoustic trauma from an extremely loud noise, can also transmit enough force to rupture the eardrum. When the membrane tears from any of these causes, the blood drains out into the external canal. The presence of blood from a middle ear source indicates a breach of the body’s barrier, potentially increasing the risk of infection.
Urgent Symptoms Requiring a Doctor Visit
While minor causes are common, certain accompanying symptoms suggest the bleeding is linked to a serious injury or infection and warrant immediate medical evaluation. The most concerning sign is the presence of sudden, severe pain that may or may not be followed by abrupt relief, which can indicate an acute eardrum rupture. Any noticeable change in hearing, such as sudden hearing loss or a muffled sensation, should be promptly assessed by a healthcare professional.
The onset of vestibular symptoms, including dizziness, vertigo, or a persistent ringing or buzzing sound known as tinnitus, suggests potential damage to the inner ear structures. Furthermore, the bleeding should be evaluated if it is heavy, persistent, or accompanied by other discharge that is clear, yellowish, or foul-smelling. These discharges can signal a deeper infection or, in the case of head trauma, possibly the leakage of cerebrospinal fluid.
A high fever, facial weakness, or severe headache paired with ear bleeding are signs of a widespread infection or a more extensive injury. If the bleeding occurred after a recent head injury, a fall, or a direct blow to the ear, seek emergency care immediately, as this could be indicative of a temporal bone fracture or other serious internal trauma.