What causes ear bleeding (otorrhagia)?

Dried blood, small amounts of blood in ear wax & blood clots

Blood in ear: Causes and Treatment, Q-Tips and cleaning risks

Ear bleeding is a symptom you should not ignore. Learn more about causes and available treatments for ear bleeding. If you are experiencing hearing loss, consider getting your hearing tested for free at a Miracle-Ear center near you.

Reviewed by

Dr. Thomas Tedeschi, Au.D.

Chief Audiology Officer, Miracle-Ear

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Blood in ear with or without pain

Ear bleeding can be painless or painful. In both cases, ear bleeding must be monitored as it can be a sign of a larger concern. Sometimes, ear bleeding can present as blood in ear wax and not outright bleeding from the ear.

There are many causes for ear bleeding ranging from small sores caused by improper use of a cotton swab or Q-Tip, to more dangerous causes such as a head injury or an acoustic trauma. When more dangerous causes occur your eardrum can be injured or perforated and extreme pain can coincide with ear bleeding.

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Why your ear may bleed and causes of blood in ear

Ear bleeding is usually a symptom of a perforated eardrum due to ear infection or trauma to the ear, but there are multiple potential causes. Learn some of the most common causes that can lead to bleeding from the ear below. Here's what can cause bleeding in the ear:

One cause of ear bleeding is the presence of a small sore or superficial wound inside the ear canal due to frequent use of Q-Tips and cotton swabs, an incorrect practice though common in many ear cleaning routine.

In fact, the cotton swab, rubbing continuously against the thin walls of the ear canal, can tear the surface or, in serious cases, cause the rupture or perforation of the eardrum. In less serious cases you will not feel pain but may notice blood on your cotton swab or earwax mixed with blood. In more serious cases you may experience ear pain and hearing difficulties (temporary hearing loss).

Eardrum perforation can also occur due to other foreign objects in the ear canal that can tear the tympanic membrane; this is one of the most common causes of ear bleeding in children, who tend to insert small objects into their ears (like toys) more often. If this occurs, other symptoms include ear pain and temporary hearing loss.

Acute or chronic ear infections, like otitis media, can cause ear bleeding. In the case of purulent middle ear infections, tympanostomy tubes or pressure equalization (PE) tubes may be required. Blood often collects in the ear after the operation. Another example of an ear infection that can lead to bleeding from the ear is myringitis. At the same time, middle ear infections can lead to rupture of the tympanic membrane and subsequent otorrhagia.

In case of minor eardrum injures, there is usually only minimal ear bleeding. An eardrum perforation is also only about the size of a pinhead, which is why minor injuries to it often heal quickly.

A rapid change in atmospheric pressure, in situations such as high diving, scuba diving or air travel can cause barotrauma or barotraumatic otitis. This can lead to ear bleeding, together with ear pain, dizziness and tinnitus.

Ear bleeding can be caused by head injuries and traumas. Experiencing ear bleeding after a head injury or trauma can be a sign of a skull base fracture. When this occurs, there is no localized damage to the ear or eardrum at the base of the ear bleeding, but there are hemorrhagic foci in other locations.

In hypertensive patients with acutely high blood pressure, patients report being able to hear the blood flowing in the vessels of the ear as noise. Because ears contain many blood vessels, increased blood pressure can become audible noise due to the sensitive sensors in your ears.

If you see blood in a child's ear, the cause may be otitis media, also called a middle ear infection. Other signs of otitis media include severe exhaustion and fever. When a child experiences a middle ear infection, the middle ear fills with fluid or pus. Middle ear infections often resolve themselves with time.

Rarely, bleeding from the ear can be traced to the presence of malignant tumors of the ear canal. Accompanying symptoms include headaches, earache, facial pain and blurred or altered vision. If you are experiencing these symptoms, please contact your doctor or see an oncologist as soon as possible.

Why is my ear piercing bleeding? Blood in ear after piercing can occur due to several reasons, including infection, which can lead to bleeding, swelling, and discharge.

Trauma is another common cause, as accidental bumping, tugging, or pulling on the piercing can cause bleeding. Additionally, an allergic reaction to the metal in the jewelry can also result in ear bleeding.

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Pulsing noise in ears: Ringing in ears and blood pressure

Hearing the blood flow in your ears is not related to ear bleeding. It likely caused by pulsatile tinnitus.

Pulsatile tinnitus can be caused by circulatory dysfunction. However, noise pollution, like listening to music with earphones, the prolonged intake of drugs such as antibiotics and diuretics, and any trauma to the head and neck could cause the onset of rhythmic pulsations. Pulsatile tinnitus can be easily diagnosed by your doctor through a physical examination of the head and neck.

Traces of blood in baby's ear wax

Bloody earwax is usually caused my minor injuries and are accompanied with minimal ear bleeding and small amounts of blood present in the earwax. These cases often resolve on their own. If other symptoms are present it is good to call your doctor to avoid following long-term complications like hearing loss or meningitis that can come from an infection.

In fact, another potential cause of ear bleeding in babies and children may be otitis media. Further indications are severe exhaustion and fever in children.

If you notice dried blood in your baby's ear, it's important to handle the situation calmly and take the following steps:

Do not insert anything: Avoid inserting anything into your baby's ear, including cotton swabs or fingers, to prevent further irritation or injury;
Clean gently: Use a clean, damp cloth to gently wipe around the outer ear to remove any visible dried blood. Avoid cleaning inside the ear canal;
Monitor for symptoms: Watch for any signs of discomfort, pain, or unusual behavior from your baby, which may indicate an underlying issue requiring medical attention;
Consult a pediatrician: It's advisable to seek medical advice from a pediatrician or healthcare provider. They can examine your baby's ear to determine the cause of the bleeding and recommend appropriate treatment;
Avoid earwax removal: Refrain from attempting to remove earwax or investigate further on your own, as this can potentially aggravate the situation.

Dried blood in a baby's ear can be caused by various factors, including minor trauma, irritation, or underlying conditions. It's essential to seek professional medical evaluation to ensure proper diagnosis and appropriate management for your baby's well-being.

Your baby's ear may be bleeding due to several potential reasons, such as:

Trauma: Accidental bumps or scratches to the ear can cause minor cuts or tears, leading to bleeding;
Ear infection: Infections in the outer ear (otitis externa) or middle ear (otitis media) can cause inflammation and irritation, which may result in bleeding;
Foreign object: Sometimes, small objects or debris can get lodged in the ear canal, causing irritation and potentially leading to bleeding;
Skin conditions: Conditions like eczema or psoriasis affecting the ear canal skin can cause dryness, itching, and subsequent bleeding.

If you notice bleeding from your baby's ear, it's essential to remain calm and avoid inserting anything into the ear. Consult with a pediatrician or healthcare professional for proper evaluation and treatment to address the underlying cause and ensure your baby's ear health.

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Treatment – how to stop ear bleeding

Because ear bleeding is a symptom of another condition, its treatment involves identifying the root cause. When the cause is treated, the bleeding will stop. These treatments include:

Watchful waiting: when the cause is the presence of superficial wounds of the ear canal or minor eardrum injuries, the ear bleeding will usually stop after a short period of time;
Anti-inflammatory medication: when an ear infection is the underlying cause of ear bleeding, the doctor may administer anti-inflammatory drugs to counteract inflammation and/or antibiotic or antiviral drugs;
Surgery: In the presence of particularly severe conditions, it may even be necessary to intervene surgically, as can happen in the case of severe tympanic perforation or in the case of severe head trauma;
Pain relieving medication: sometimes the doctor may decide to prescribe pain-relieving drugs, sedative drugs, antiemetic drugs, etc. to the patient. in order to control the symptoms that may occur in association with ear bleeding.

Consult a doctor in the following cases:

Dizziness, drowsiness and vomiting
Severe pain in the ear area
Nosebleed
Inability to follow movement with the eyes
Tinnitus
Head trauma
Altered state of consciousness

Your doctor will be the first professional to examine your ear bleeding. After reviewing your medical details, they will perform otoscopy (a tool will be inserted into the ear to better understand the infection) to diagnose whether you are experiencing an inflammation or a lesion of the eardrum. Depending on the diagnosis, they will prescribe either medication or refer you to a specialist for further testing. Please note if you are experiencing bleeding caused by head trauma, a CT scan or MRI is prescribed to check for any skull fractures.

To stop ear bleeding at home, you can follow these remedies:

Clean the area: Gently clean around the ear with a clean cloth or tissue to remove any blood. Avoid inserting anything into the ear canal;
Apply pressure: If the bleeding is from a cut or piercing, apply gentle pressure with a clean cloth or sterile gauze for a few minutes to help stop the bleeding;
Ice pack: Apply an ice pack wrapped in a cloth to the outside of the ear for 15-20 minutes to reduce swelling and help stop the bleeding;
Elevate the head: Keep your head elevated to reduce blood flow to the area, which can help minimize bleeding;
Avoid irritants: Keep the ear dry and avoid using earphones, earbuds, or inserting anything into the ear canal until it heals;
Antibiotic ointment: If the bleeding is due to a minor cut or abrasion, you can apply a small amount of antibiotic ointment to prevent infection;
Rest and hydrate: Ensure you get plenty of rest and stay hydrated to promote healing.

If the bleeding persists or is accompanied by severe pain, dizziness, or hearing loss, seek medical attention immediately.

How to stop ear bleeding after cleaning with cotton bud?

Ear bleeding after cleaning with Q-tip typically occurs due to accidental trauma to the delicate tissues inside the ear canal or the eardrum. Cleaning too vigorously with cotton swabs or other objects can cause scratches or cuts, leading to bleeding. If it happens you can follow these steps:

Stay calm: Remain calm and avoid panicking, as stress can exacerbate bleeding;
Stop cleaning: Immediately stop any further cleaning or insertion of objects into the ear;
Apply pressure: Gently press a clean cloth or sterile gauze against the bleeding area. Hold it in place for several minutes to help stop the bleeding;
Avoid irritants: Refrain from using earphones or inserting anything into the ear canal until it has healed;
Monitor the situation: Keep an eye on the bleeding. If it continues or worsens, seek medical attention.

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Risks and consequences of untreated ear bleeding or otorrhagia

Several complications can arise if the cause of ear bleeding is not treated. These complications depend on the diagnosis and symptoms:

Untreated otitis media can cause bone suppuration which causes damage to the bones of the skull and jaw;
A head injury can lead to complete deafness as a complication of a possible skull fracture and possible leakage of inner ear fluid;
A head injury with blood leaking from the ear can also indicate an increased risk of stroke;
A damaged or perforated eardrum can suffer irreversible damage such as improper vibration of the bones of the middle ear;
A perforation in the eardrum can make it easier for water to enter the ear and lead to more severe otitis media;
Wounds in the ear canal area can also become infected, which in the worst case can lead to otitis externa, which is a severe chronic inflammation of the ear canal.

FAQs about ear bleeding

Hearing your heartbeat or blood pulsing in your ear, known as pulsatile tinnitus, can be unsettling. This phenomenon typically occurs due to changes in blood flow near the ear, which can amplify the sound of blood circulating through nearby vessels.

Factors such as increased blood volume, changes in blood vessel structure, or conditions affecting the ear or cardiovascular system can contribute to this perception. It's advisable to seek evaluation by a healthcare professional to identify the underlying cause and determine appropriate management options for pulsatile tinnitus.

The presence of blood in the ear can indicate various underlying conditions or injuries. It may suggest:

Trauma: Injury to the ear, such as a blow to the head or a punctured eardrum (tympanic membrane), can cause bleeding in the ear;
Ear infection: Severe infections of the ear canal (otitis externa) or middle ear (otitis media) can sometimes lead to bleeding;
Foreign object: A foreign object inserted into the ear canal can cause abrasions or cuts, resulting in bleeding;
Barotrauma: Rapid changes in air pressure, such as during scuba diving or air travel, can cause barotrauma to the ear, potentially leading to bleeding;
Underlying medical conditions: Conditions affecting blood clotting (coagulopathy) or vascular disorders can increase the likelihood of bleeding in the ear.

Internal ear bleeding can be alarming and typically indicates underlying issues with the ear's delicate structures. One common cause is a ruptured eardrum, often resulting from sudden changes in pressure, trauma, or improper handling such as inserting objects into the ear canal.

Middle ear infections, particularly severe cases, can also inflame and irritate the eardrum, potentially leading to bleeding. Foreign objects lodged in the ear canal can scratch or injure the delicate tissues, causing bleeding as well. These conditions necessitate prompt medical attention to determine the cause and ensure appropriate treatment for optimal recovery and prevention of complications.

Yes, bleeding from the ear can be considered a medical emergency in certain situations. It may indicate serious underlying conditions such as a ruptured eardrum, severe ear infection, or head injury.

Bleeding from the ears after a head injury can occur due to several potential causes:

Ruptured eardrum: A significant impact or trauma to the head can cause the eardrum (tympanic membrane) to rupture or tear. This can result in bleeding from the ear canal;
Skull fracture: A severe head injury, such as a skull fracture, can cause bleeding from the ear due to damage to blood vessels near the ear or from cerebrospinal fluid leaking through the ear canal;
Middle ear injury: Trauma to the head may also cause injury to the middle ear structures, leading to bleeding;
Concussion: In some cases, a concussion or traumatic brain injury can cause bleeding from the ears due to the force of impact affecting the delicate structures within the ear;
Temporal bone fracture: Fractures of the temporal bone, which houses the structures of the inner and middle ear, can lead to bleeding from the ear canal;
Internal ear injury: Damage to the inner ear structures, such as the cochlea or semicircular canals, can also cause bleeding from the ear.