Otorrhagia : bleeding from the ear
Otorrhagia is the externalization of red blood through the ear canal. Its diagnosis is thus easy and the cause, in general, suspected as of the interrogation.
Let’s put aside at once :
• The otorrhagia secondary to a traumatism of the base of the skull and in particular of the rock, at the time of an accident of the public way for example, which poses the serious problem, in this case, of a communication between the outside (which generally requires a tympanic perforation) and the brain in the event of meningeal breach, which darkens the prognosis. An otorrhagia can then rapidly become an oliquorrhoea by leakage of meningeal fluid. Obviously, this otorrhagia is associated with signs specific to the fracture of the rock1 and in particular a more or less severe deafness, or even cophosis (total deafness), of tinnitus and vertigo severe.
• Otorrhagia during diving is the subject of a separate article, to be consulted here.
Let us distinguish, for the simplicity of the presentation, the otorrhagia of the child and that of the adult.
In the child :
The mother arrives urgently at the specialist because the ear bleeds without any other pain but the sight of blood is a source of concern.
The absence of pain and the questioning are rich in information. In general, there has been trauma to the ear canal by a finger, any other object, most often a cotton swab (sometimes the day before), trauma carried out by the parent or even the child, if big enough. The examination confirms the injury to the ear canal, which is not serious, but the ENT specialist must forbid ear cleaning.
The otorrhagia is accompanied by acute pain and the impression of a blocked ear and immediately follows an aggressive ear cleaning. This time the lesion is on the eardrum with a more or less important tear confirmed by the doctor. It is necessary to avoid any introduction of water and certain drops in this emergency context in order not to slow down the healing which, often, but not always, will be spontaneous.
Sometimes the symptomatology is accompanied by crying, pain, or even fever in a small child with a cold and no notion of trauma. The otorrhagia occurs in the middle of the night accompanied by cries in the child who, once the emission of blood has taken place, goes back to sleep, relieved.
The next day, the distraught mother, when she has not contacted a doctor in emergency, goes to her ENT. The lesion is characteristic on this clinical context of a viral otitis. The examination reveals a “phlyctenular myringitis” that is to say an eardrum strewn with micro phlyctenes (vesicles) filled with blood. It is the perforation of one of these vesicles (or several) on a lingering rhinopharyngitis that creates pain and blood emissions. Treatment is limited to treating the nasal infection and antibiotic and anti-inflammatory drops are prescribed.
In adults :
The analogy with children is great and often the same causes create the same effects (cotton swabs).
A chronic otorrhea (purulent discharge) can be complicated by otorrhagia when the ear that has been leaking for a long time with a long-standing tympanic perforation and a more or less severe destruction of the case (which is located behind the eardrum) is very inflammatory. The case is said to be granulomatous and bleeds on contact. In other cases, a fleshy, bloody bud closes the perforation and bleeds abundantly at the slightest contact. Treatment is based on drying the ear and preventing water from entering the body. Reconstruction or cleaning surgery may be necessary at a later date.
A malignant tumor of the ear (very rare).
A vascular tumor called glomus tumor (also very rare). It is a benign tumor with vascular starting point at the level of corpuscles surrounding the vessels (the internal jugular vein here which passes in the bottom of the middle ear).
Diagnosis evoked on deafness with pulsatile tinnitus and the examination finds a purplish red “raspberry” mass located behind and at the lower part of the eardrum. The treatment is surgical after embolization of the tumor by small beads sent into the circulation which temporarily interrupt the blood flow specific to the tumor.
In conclusion :
Very frequently benign and of obvious cause, otorrhagia poses some imperatives.
Do not introduce anything into the ear canals to “clean” them, as earwax will spontaneously flow out, unless prevented.
The ban on cotton swabs for 2020 is finally a common sense measure for all the “recalcitrant”.
Some causes, much rarer than the injury, require a specialized opinion but their occurrence, quite different, is accompanied by associated clinical signs. The treatment is adapted to the cause found.
1 The rock is a bony block that houses part of the outer ear, the middle ear and the inner ear.
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