Bleeding from the Ears, Nose, or Mouth

Editor's Note: This excerpt is from Understanding Equine First Aid by Michael Ball, DVM. The book is available from

As previously mentioned, the presence of blood in the ear canal after trauma can indicate a skull fracture. Additional clinical signs might include severe depression, seizing, and/or holding the head in a tilted manner. These animals should be evaluated by a veterinarian as soon as possible. Bleeding from the nose also can be considered a veterinary emergency, especially if the hemorrhage is coming from one nostril and is not associated with exercise. Bleeding from the nose (usually both nostrils) during strenuous exercise can be a result of exercise-induced pulmonary hemorrhage (EIPH).

Exercise-induced pulmonary hemorrhage is common in racehorses and is actually a bleeding within the lungs, which is manifested as bleeding from the nostril in severe cases. If a horse bleeds as described after exercise, the horse should have this diagnosis confirmed (and other causes ruled out) by a veterinarian using endoscopy.

Another cause of bleeding from the nose (usually one nostril) is called guttural pouch mycosis. The guttural pouch is a structure in the horse's head (very few other mammals have this structure) that opens/drains into the nasal cavity. A number of very vital structures travel within the guttural pouch, one being the internal carotid artery. Mycosis refers to a fungal infection--guttural pouch mycosis is a fungal infection within the guttural pouch. As the infection advances, it can erode the internal carotid artery and, if left untreated, eventually lead to a severe and typically fatal hemorrhage.

It is because of this disease that hemorrhage from the nose should be taken very seriously, even though it is possible for a laceration, foreign body, tumor, or other cause to be responsible for the bleeding. The treatment for guttural pouch mycosis generally involves surgery. A horse experiencing hemorrhaging from the nose should be kept as calm as possible and be evaluated by a veterinarian as soon as possible.

Another potential cause for bleeding from the nostril is a type of tumor called an ethmoid hematoma. This diagnosis can be distinguished from guttural pouch mycosis with endoscopy. Ethmoid hematomas tend to have a much better prognosis than guttural pouch mycosis.

About the Author

Michael Ball, DVM

Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, N.Y. He is also an FEI veterinarian and works internationally with the United States Equestrian Team.

Ball authored Understanding The Equine Eye, Understanding Basic Horse Care, and Understanding Equine First Aid, published by Eclipse Press and available at or by calling 800/582-5604.

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