Otorrhagia in strangulations: An important but often underestimated finding in forensic pathology

In forensic practice, it is not always easy to determine whether a person has died from strangulation. The recommended physical examination includes a thorough inspection of the head, neck, oral cavity, and eyes. Ligature marks are sometimes absent or poorly delineated, especially when soft devices are used. Otorrhagia is poorly described in neck compression, and it is often an underestimated finding. Here, we report a case of massive bilateral otorrhagia produced during strangulation (death by garrotting), and we discuss the possible pathophysiological mechanisms. As our case demonstrates, otorrhagia can be a sign of neck compression and can aid in the diagnosis of death from strangulation. Therefore, a thorough examination of the external ear and otoscopy are recommended procedures in cases concerning for strangulation.