Bleeding from the Ear

Where the blood comes from

The ear canal is lined with thin skin over bone that bleeds easily when scratched. The eardrum is a thin membrane that can tear. Behind it, the middle ear can fill with blood or infected fluid that escapes through a tear. After a severe head injury, blood can come from a fracture of the temporal bone, the part of the skull that holds the ear.

Common causes of bleeding from the ear

Ear canal injury

The most common cause. Cotton swabs, fingernails, hairpins, keys or earbud tips can scrape the canal and cause a small bleed. People with eczema or dry skin in the ears scratch more. The bleeding is usually brief and the scratch heals in a few days. See ear canal injury.

Ruptured eardrum

A hole in the eardrum (eardrum perforation) can cause a small amount of blood, often with clear or pus-like discharge. Causes include:

• Middle ear infection: pressure from pus bursts the eardrum. Severe ear pain often eases suddenly as the drum ruptures and discharge appears. Common in children with otitis media.
• Pressure injury (barotrauma): flying, scuba diving or a slap or blast to the ear.
• Objects pushed too far into the ear.
• Very loud noise, such as an explosion.

Symptoms include sudden pain, muffled hearing, ringing and sometimes dizziness.

Outer ear infection

Swimmer's ear causes a swollen, painful, itchy canal with discharge that may be blood-tinged. Pulling the earlobe hurts.

Foreign objects

Children often put beads, small toys or food in their ears. Insects can crawl in. Trying to remove them at home can scratch the canal and push them deeper. Button batteries cause chemical burns and must be removed urgently.

Head injury

Blood from the ear after a fall, crash or blow to the head can mean a skull fracture through the temporal bone. Clear, watery fluid can be cerebrospinal fluid leaking from around the brain. Other signs include bruising behind the ear (Battle's sign), bruising around the eyes, hearing loss and facial weakness.

Less common causes

• Cholesteatoma: a skin growth in the middle ear causing smelly, sometimes bloody discharge and hearing loss
• Granulation tissue or polyps from chronic infection
• Bullous myringitis: painful blood-filled blisters on the eardrum with viral infections
• Blood thinners or bleeding disorders, which make minor bleeds heavier
• Ear canal or middle ear tumors (rare)

Clues to the cause

What to do if your ear is bleeding

1. If it follows a head injury, call 911 or your local emergency number. Keep the person still. Do not plug the ear or stop the flow.
2. For other bleeding, sit up and let it drain onto a clean cloth or loosely placed cotton on the outer ear.
3. Do not push anything into the ear canal, and do not use ear drops unless a clinician has checked the eardrum.
4. Keep water out of the ear.
5. Take acetaminophen (paracetamol) or ibuprofen for pain, following the label dose.
6. Get the ear checked by a doctor, even if the bleeding stops.

How doctors diagnose ear bleeding

A clinician asks what happened and about pain, hearing, dizziness and discharge, then looks in the ear with an otoscope after gently cleaning out blood. They check hearing and facial nerve function. Tests may include a hearing test, a swab of discharge, and a CT scan of the head and temporal bones after trauma. An ENT specialist may use a microscope to look closely at the eardrum.

Treatment

• Canal scratches: usually heal on their own in a few days. Keep the ear dry.
• Ruptured eardrum: most heal within 2 to 8 weeks. Keep water out; antibiotic drops or tablets may be prescribed if infection is present. A hole that does not heal may need a patch or surgery (tympanoplasty).
• Infections: antibiotic ear drops for outer ear infection; oral antibiotics for some middle ear infections.
• Foreign objects: removed by a clinician with suction, small hooks or forceps.
• Skull fracture: hospital observation, and surgery if there is brain injury, ongoing fluid leak or nerve damage.

Prevention

• Do not put cotton swabs or other objects in your ear canals. Ear wax normally clears itself.
• Equalize pressure when flying or diving by swallowing, yawning or gently pinching the nose and blowing.
• Wear ear protection around loud noise and blasts.
• Treat ear infections promptly and dry ears after swimming.

Frequently asked questions

Is bleeding from the ear serious?

It depends on the cause. A little blood after scratching the canal is usually minor. Bleeding after a head injury is an emergency because it can mean a skull fracture. Bleeding with pain, hearing loss or dizziness suggests a ruptured eardrum and should be checked.

Why is my ear bleeding after using a cotton swab?

The swab probably scratched the delicate skin of the ear canal or, if pushed deep, damaged the eardrum. A small scratch heals in a few days. See a doctor if you have pain, muffled hearing, ringing, dizziness or bleeding that continues.

Can an ear infection cause bleeding?

Yes. A middle ear infection can build up enough pressure to burst the eardrum, releasing blood-tinged pus. Outer ear infections can also cause bloody discharge. Most heal with treatment, but you should see a doctor to confirm the cause and protect hearing.

Will a ruptured eardrum heal on its own?

Most do, usually within a few weeks to 2 months. Keep the ear dry and avoid putting anything in it. If hearing does not return or discharge continues after 2 to 3 months, an ENT specialist may recommend a repair.