EpistemisOtohemorrhage
Specialty: Otolaryngology.
Why it occurs
- Trauma of the external auditory canal due to aggressive self-cleaning with swabs or direct scratching
- Fracture of the base of the skull with involvement of the temporal petrous bone
- Hemorrhagic external otitis secondary to an acute bacterial infection with formation of blisters
- Rupture of the tympanic membrane due to severe barotrauma or acoustic trauma
- Presence of a vascularized tumor in the middle ear such as the jugulotympanic glomus tumor
Initial workup
Otoscopy and gentle microaspiration of clots under a microscope to specify the point of origin of the bleeding, high-resolution CT of the petrous bones without contrast to evaluate possible fracture lines, tympanometry (only if the tympanic membrane is intact and the canal is clean), and MRI of the middle ear with gadolinium in the event of suspicion of vascular tumor pathology.
red flags
Continuous active bleeding that is difficult to control, concomitant otoliquorrhea (presence of cerebrospinal fluid mixed with blood), acute onset ipsilateral facial paralysis, loss of level of consciousness, previous high-energy head trauma, or involvement of lower cranial nerves (IX, X, XI).
Standard management
- Ear drops with ciprofloxacin and dexamethasone — 4 drops every 12 hours if duct laceration is identified without massive active bleeding to prevent superinfection
- Local hemostatic tamponade with absorbable gelatin sponges or gauze impregnated with tranexamic acid — applied in a controlled manner by a specialist under microscopic vision
- Prophylactic systemic antibiotic treatment with amoxicillin-clavulanic acid (875/125 mg every 8 hours orally if there is suspicion of an open petrous fracture or contamination of the middle ear).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 5
- Treatment options
- 3