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What causes ear bleeding (otorrhagia)?

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

Blood in ear: 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. 

Blood in ear with or without pain

Ear bleeding can occur with or without pain. 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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Care for your ears

One of the best ways to care for your ears and prevent hearing loss is to get them properly examined by a hearing professional. Find your nearest Miracle-Ear store to get started on your journey to better hearing.

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.

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.
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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 children’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.

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Prevention is key

Never underestimate the importance of ear care, your hearing might depend on it.

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.

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Risks and consequences of untreated ear bleeding

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.

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