Otorrhagia is bleeding from the ear, most often linked to trauma to the outer or middle ear, but which can also be of inflammatory or infectious origin. It is very frequently benign, except in cases of severe trauma and perforation of the eardrum. What to do depends on its origin.

Definition

Otorrhagia is defined as the flow of blood through the auditory meatus, that is to say the opening of the external auditory canal, following trauma, infection or inflammation.

The blood can be pure or mixed with purulent secretions.

Causes

Most otorrhagia results from trauma. Most often, it is a benign sore of the external ear canal created by cleaning with a cotton swab too deep, by another object or even by simple scratching.

In the most serious cases, the trauma is localized to the middle ear and is accompanied by a wound of the eardrum (the thin membrane that separates the external auditory canal from the middle ear), sometimes indicative of more serious damage. : lesions of the chain of ossicles, fracture of the rock …

These traumas occur in different contexts:

• head trauma (car or sports accident, fall, etc.),
• trauma linked to a sudden increase in pressure: ear blast (organ damage caused by the blast effect and sound blast) following an explosion, or even a slap on the ear, diving accident (barotrauma) …

Acute or chronic otitis media (especially dangerous chronic otitis due to the presence of a skin cyst called cholesteatoma in the eardrum) also sometimes causes otorrhagia.

Other causes of otorrhagia include inflammatory polyps and granulomas as well as tumor pathologies.

Diagnostic

The diagnosis is based primarily on questioning the patient, which aims to determine the circumstances of the onset of bleeding and any history of ENT.

Examination of the discharge and clinical examination confirm the diagnosis. To better visualize the external auditory canal and the eardrum, the doctor performs an otoscopy. This is an examination of the ear performed using either a hand-held optical device called an otoscope or a binocular microscope – which provides a more intense light source but requires immobilization of the head – , or an oto-endoscope, consisting of a probe fitted with an optical system and a lighting system.

Depending on the cause of the otorrhagia, other tests may be necessary:

• imaging workup (scanner or MRI),
• instrumental acumetry (hearing test), audiometry (hearing measurement),
• biopsy,
• ear sample for bacteriological examination …

The people concerned

Ear bleeding is a fairly rare situation. Anyone, child or adult, can have an otorrhagia from trauma or infection.

Appearance of otorrhagia

If otorrhagia is the result of a simple scratch or scratching of the external ear canal, it takes on the appearance of a small bloody discharge. For larger trauma, the flow of blood may be more abundant, the ear canal being filled with clots of dried blood.

In the most severe cases, a clear discharge of the otoliquorrhea type (“rock water” appearance) may be associated with the blood flow, indicating a leak of cerebrospinal fluid through a meningeal breach. 

In the case of acute otitis media, otorrhagia consisting of red blood suggests the rupture of a hemorrhagic blister (phlyctene), in the context of influenza otitis due to a virus, called influenza phlyctenular otitis. When otitis is of bacterial origin and the eardrum ruptures under the pressure of the pus accumulated in the eardrum, the blood is mixed with more or less thick purulent and mucous secretions.

Associated signs

Otorrhagia can be isolated or combined with other symptoms, which vary depending on the underlying cause:

• a feeling of blocked ears and severe pain after aggressive ear cleaning,
• more or less severe deafness, tinnitus, dizziness or even facial paralysis following a fracture of the rock,
• nasopharyngitis with stuffy nose and fever, ear pain relieved by the discharge, hearing loss in acute otitis media,
• pain, tinnitus and dizziness following barotrauma,
• severe pain and hearing loss after a blast
• deafness with pulsatile tinnitus (perceived as the pulse at a rhythmic rate) when the cause of the otorrhagia is a benign vascular tumor called a glomus tumor …

Treatments for otorrhagia are adapted on a case-by-case basis after clinical examination and cleaning of the lesions.

Minor lesions usually heal spontaneously without any treatment. In other cases, depending on the underlying cause and the severity, treatments may include:

• anti-inflammatory and analgesic drugs;
• local care to accelerate healing;
• antibiotics if an infection is present (avoid getting fluids into the ear canal so as not to increase the risk of superinfection);
• corticosteroids associated with vasodilators when the inner ear is affected following a sound trauma;
• repair of the eardrum (tympanoplasty) involving a graft of connective tissue or cartilage in the event of a persistent or complicated lesion;
• other surgical treatments (head trauma, blast, tumor, cholesteatoma, etc.) …

It is not always possible to prevent otorrhagia. However, some injuries are preventable, starting with those attributable to too aggressive cleaning of the ear – ENTs welcome the upcoming ban on the sale of cotton swabs, originally dictated by considerations ecological.

People exposed to sound trauma should wear ear protection.

Diving trauma is also partly preventable by learning maneuvers aimed at balancing the pressure between the outer ear and the middle ear. It is also necessary to respect the contraindications (do not dive when suffering from an infection of the upper respiratory tract).