A 25-year-old pediatric resident stopped by the WiscMed booth at the American Association of Pediatrics. She experienced bleeding from her left ear canal two weeks ago. She does not report any trauma to the ear. The bleeding was minor and lasted only a short time. This image was obtained of her left ear.
What are possible explanations for the reported bleeding?
The image shows a healthy and normal tympanic membrane (TM, ear drum) and malleus with an apparent anomaly on the posterior-superior portion of the ear canal. If the resident had not reported a remote episode of bleeding, this could be assumed to be cerumen (ear wax). Given the report of past ear canal bleeding, this area most likely represents dried blood, possibly from a minor scratch. Since the resident was clear that there had been no trauma to the ear canal, the source is a matter of speculation. Possible causes include unrealized trauma from a Q-tip, an insect bite, or less likely a superficial vascular anomaly that is prone to injury. Follow-up would only be necessary if there is a repeat of significant bleeding.