Abstract

Introduction: Otorrhagia is an uncommon finding in forensic practice and is classically associated with skull base fractures, temporal bone trauma, or barotraumatic events. However, the literature suggests that ear bleeding may also rarely occur in deaths due to neck compression, including strangulation and hanging. Case Presentation: We report the case of a man died by hanging. External examination revealed an oblique ligature mark on the neck, conjunctival petechiae, and bilateral otorrhagia. At autopsy, no fractures of the skull vault or skull base were identified. Otoscopic examination showed bilateral tympanic membrane laceration. Internal examination of the neck disclosed small hemorrhagic infiltrates in the perithyroid muscles and prevertebral soft tissues, as well as bilateral carotid intimal tears consistent with Amussat’s sign. Moreover, a unilateral lesion involving the petrous portion of the temporal bone was observed. The distinctive feature of this case is the association of bilateral otorrhagia, bilateral tympanic membrane laceration, and unilateral petrous bone erosion in the absence of skull base fracture. Histology showed visceral congestion, pulmonary overdistension with rupture of interalveolar septa, cerebral edema, myocardial fiber fragmentation and trabecular remodeling and areas of necrosis of the bone fragment sampled from the right petrous temporal bone. Death was attributed to mechanical asphyxia due to hanging. Conclusions: This case suggests that bilateral otorrhagia in hanging may result from the combined effects of impaired cervico-cephalic venous drainage and pressure changes transmitted to the middle ear during forceful respiratory efforts. The pre-existing unilateral petrous bone lesion may have acted as a local predisposing factor, although its etiology and actual contribution cannot be established with certainty. Otoscopic examination should therefore be regarded as a potentially useful adjunct in selected cases, particularly for documenting auricular findings and supporting differential diagnosis.

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