Otorrhagia is commonly associated with cranial trauma and diving accidents. In some forensic manuals, bleeding in the ears is anecdotally associated with strangulation. We report 2 cases of criminal strangulation with hemotympanum and otorrhagia, emphasizing the importance of this sign with strangulation. We present the proposed pathophysiology of the injuries and the value of otoscopic evaluation to complete the external examination in forensic cases suspicious for strangulation.