# Blood From Both Ears: A Hidden Mandibular Condyle Fracture Revealed by Otorrhagia

## TL;DR

Bilateral ear bleeding after a chin injury can signal hidden jaw fractures that require careful imaging and treatment to avoid complications.

## Contribution

This case highlights the under-recognized link between chin trauma, ear canal bleeding, and mandibular condyle fractures.

## Key findings

- Bilateral otorrhagia after chin trauma can indicate fractures of the mandibular condyle and external auditory canal.
- Computed tomography and otoscopy are essential for diagnosing and managing these injuries effectively.
- Early intervention with clot removal and canal packing can prevent long-term auditory complications.

## Abstract

Otorrhagia following mandibular trauma may appear straightforward; however, underlying external auditory canal (EAC) fractures and associated condylar injuries can be easily overlooked without targeted evaluation. We present the case of an 88-year-old man who developed bilateral ear bleeding and hearing loss after falling and striking his chin. Computed tomography revealed bilateral mandibular condyle fractures with associated fractures of the anterior walls of both EACs. The canals were filled with hematoma, and hearing loss was presumed to result from mechanical obstruction. Otoscopic examination after clot removal confirmed mucosal injury, and auditory symptoms improved following decompression and ear wick placement.

This case highlights a diagnostic pitfall in which clinicians may overlook condylar fractures as a cause of EAC injury. The mandibular condyle lies immediately inferior to the EAC anterior wall, and superior displacement during chin trauma may result in canal injury. Bilateral otorrhagia after chin trauma should therefore raise clinical suspicion for underlying mandibular condyle fractures and associated EAC disruption.

Radiological assessment with computed tomography (CT) and direct visualization via otoscopy are essential to detect these injuries early and guide conservative management. Our experience emphasizes that visible otorrhagia alone does not reveal the full extent of injury. Prompt clot removal and canal packing helped prevent adhesion and long-term auditory complications in our case.

Clinicians should maintain a high index of suspicion for EAC fractures and mandibular condyle injuries in patients with chin trauma and otorrhagia, even when bleeding is visibly apparent.