What Is Ear Bleeding?

Overview

Ear bleeding is when blood is seen draining out of the ear canal. It is also known as otorrhagia, aural bleeding or aural haemorrhage. Trauma, ear infections, foreign objects, ruptured eardrums, head injuries, or ear cancer are just a few of the causes.

Causes of ear bleeding

Trauma or injury: A blow to the head, a head injury, or inserting sharp objects into the ear can cause bleeding.

• Ear canal injury: An ear canal injury refers to damage or trauma to the ear canal, which is the narrow passage that connects the outer ear to the middle ear. The injury can result from various causes, including accidents, foreign objects, infections, or medical procedures
• Eardrum Injury: also known as a tympanic membrane injury, refers to damage, tear, or rupture of the eardrum, which is a thin membrane that separates the outer ear from the middle ear. The eardrum plays a crucial role in transmitting sound vibrations to the middle ear bones, which then transmit the sound to the inner ear for processing. This eardrum perforation can result from various causes, including accidents, barotrauma, infection, the insertion of objects and exposure to extremely loud noise
• Head trauma: can cause ear bleeding. This bleeding can be caused by many factors, including tympanic membrane (eardrum) rupture, skull fracture, damage of blood vessels and Otic (ear) injury because of the accident

Ear Infections: Infections of the middle ear (otitis media) or outer ear (otitis externa) can lead to inflammation and bleeding.

• Middle ear (otitis media): a middle ear infection may lead to ear bleeding. At the same time, ear bleeding is not a common symptom of middle ear infection. In certain situations, ear bleeding can be associated with middle ear infections. Such as a ruptured eardrum, an accident during cleaning or scratching aggressively as a middle ear infection can cause discomfort and itching in the ear. 

Outer ear: infections of the outer ear, known as otitis externa or swimmer's ear , can occasionally cause ear bleeding. Swimmer's ear is an infection or inflammation of the external ear canal, the portion of the ear that leads from the outer ear to the eardrum. However, bleeding is not a common symptom but occurs due to the following reasons including injury, excessive cleaning, and inflamed or irritated skin.

Ear cancer or Tumour: can cause ear bleeding as one of the possible causes. Ear bleeding in the context of ear cancer or tumours can occur due to the invasion of blood vessels within the tumour or cancerous tissue, leading to bleeding from the affected area . In addition, tumours can change the usual structure of normal tissue and lead to erosion or wounds, which can cause bleeding. Ear cancer or tumours can originate from different structures within the ear, including the outer ear, middle ear or inner ear. Some common types of ear cancers or tumours include squamous cell carcinoma, basal cell carcinoma, malignant melanoma, acoustic neuroma (vestibular schwannoma) and glomus tumours. 

Barotrauma: cause ear bleeding. Barotrauma occurs when there is a rapid change in pressure between the external environment and the middle ear, leading to injury or damage to the delicate structures of the ear.⁵ Here is how barotrauma can cause ear bleeding:

• Rupture of the eardrum: when there is a sudden and significant difference in pressure, such as during rapid ascent or descent in an aeroplane or scuba diving, the pressure on the eardrum can become imbalanced, and this can cause the eardrum to rupture, resulting in bleeding from the ear
• Damage to blood vessels: the sudden changes in pressure during barotrauma can also cause damage to the blood vessels in the ear. The increased pressure can lead to small blood vessel rupture, resulting in ear bleeding
• Other ear injuries: in addition to eardrum rupture and blood vessel damage, barotrauma can cause other injuries to the ear structures, including the ear canal and the middle ear. The ear might bleed as an effect of these injuries

Other causes are:

• Eustachian tube dysfunction
• Medications
• Blood disorders
• Allergic reactions
• Autoimmune diseases

Signs and symptoms of ear bleeding

The following are signs and symptoms associated with ear bleeding:

• Blood or blood-tinged discharge
• Pain or discomfort
• Hearing loss
• Tinnitus or perception of ringing, buzzing, or other noises in the ear without an external source⁶
• Dizziness or vertigo
• Fever and ear pain

Management and treatment for ear bleeding

The management of ear bleeding involves taking immediate steps to control the bleeding and seeking medical attention. The following are steps to manage ear bleeding:

• Stay calm
• Sit upright
• Gently clean
• Apply gentle pressure
• Do not wear earplugs
• Do not tilt the head back
• Seek medical attention

The treatment for ear bleeding depends on the underlying cause. Here are some potential treatments that may be used:

• Conservative management: in cases of mild ear bleeding, conservative management may be sufficient, and this may involve gentle cleaning, applying pressure to the ear, and observing for any changes. It is advisable to contact a healthcare provider who will provide specific instructions on managing the bleeding at home
• Topical medications: if the ear bleeding is associated with an infection, kindly contact a healthcare provider who may prescribe antibiotics, or antifungal ear drops to treat the underlying infection
• Ear packing or tamponade: in more severe cases of ear bleeding, a healthcare provider may insert an ear packing or tamponade, which involves placing a sterile dressing or specialized material in the ear canal to apply gentle pressure and control the bleeding. The packing may need to be changed or removed by a healthcare professional
• Cauterization: in certain situations, cauterization may treat specific causes of ear bleeding. This procedure involves using heat, electricity, or chemicals to seal blood vessels or cauterize a bleeding source. A trained healthcare professional typically performs it
• Surgical intervention: if the ear bleeding is due to a more severe condition, such as a tumour, injury or abnormality, surgical intervention may be necessary. Surgery aims to address the underlying cause, repair damaged structures or remove the source of bleeding

It is important to note that the management and treatment of ear bleeding should be done under the guidance of a healthcare professional. They will assess the cause and severity of the bleeding and provide the necessary treatment, including topical medications, ear packing, or further interventions depending on the underlying cause.

NB: Self-treatment or home remedies are not recommended, as they may delay proper care and worsen the condition.

Complications

Ear bleeding can be associated with several complications, depending on the underlying cause and severity. Below is potential complications occurrence: 

• Ear Infection
• Hearing loss
• Eardrum (tympanic membrane) perforation
• Balance disturbances
• Continued bleeding or haemorrhage

FAQs

Can I prevent ear bleeding?

While it may not be possible to prevent all instances of ear bleeding, there are specific measures one can take to reduce the risk. Here are some tips for potential prevention: avoid inserting objects into the ear, be cautious during ear swaps, protect ears during physical activities, Treat underlying ear conditions promptly, avoid exposure to loud noises and practice good ear hygiene.

How common is ear bleeding?

Ear bleeding, also known as otorrhagia, is not a common occurrence for most people. The prevalence of ear bleeding can vary depending on factors such as age, underlying health conditions and environmental factors.

Who is at risk of ear bleeding?

Here are some groups of individuals who may be at a higher risk of ear bleeding: Children, individuals with a history of ear infections, people with underlying ear conditions, individuals with a history of trauma or injury to the ear, those with blood clotting disorders, individuals with a history of ear surgery.

When should I see a doctor?

Seeing a doctor for ear bleeding is generally recommended, as it can indicate an underlying issue that requires medical attention. Here are some situations where one should seek prompt medical care for ear bleeding: severe or uncontrolled bleeding, injury or trauma, recurrent or persistent bleeding, associated symptoms, blood-thinning or clotting disorder, history of ear surgeries or chronic ear conditions.

Summary

Ear bleeding, also known as otorrhagia, can occur due to various factors such as trauma, ear infections, foreign objects, ruptured eardrums, head injuries, or ear cancer. It is an uncommon event for the majority of people. Symptoms include bloody or blood-tinged discharge, pain, hearing loss, and dizziness. Depending on the cause, treatment may involve conservative management, topical medications, ear packing, cauterization, or surgical intervention. It is essential to seek medical attention for proper evaluation and care to prevent complications.