Ear discharge

Otorrhea is a discharge from the ear, which can be serous, serous-hemorrhagic or purulent. Otalgia, fever, itching, dizziness, tinnitus and hearing loss can be observed simultaneously.

Be careful: sometimes the cause of discharge from the ear is cholesteatoma.

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Main Causes of Ear Discharge

Furunculosis. Infection of hair follicles (usually with staphylococci) leads to the development of furuncles in the outer third of the ear canal, which is manifested by sharp pains that intensify when chewing. In such cases, one should think about diabetes mellitus, which can debut in a similar way. On palpation, the tragus is painful, the pain intensifies when moving the auricle, a furuncle can be seen through the external auditory canal. Treatment: thermal procedures (a bottle of hot water is applied to the ear), taking adequate doses of analgesics, locally - ichthyol ointment and glycerin on a cotton swab (the swab is changed every 12 hours). If there is cellulitis or systemic manifestations, the patient is prescribed amoxicillin 250 mg every 8 hours and flucloxacillin 250 mg every 6 hours orally.

Inflammation of the middle ear. Ear pain may be followed by copious discharge of pus (if the eardrum is perforated). The discharge from the ear stops after a few days. Treatment: oral antibiotics (eg, amoxicillin 250 mg every 8 hours; infants and children are given 1/2 this dose for 3 days as sugar-free syrup).

Continued discharge from the ear indicates mastoiditis. Mucopurulent discharge from the ear is sometimes observed even in the absence of mastoiditis, especially if a tube for ventilation of the middle ear is inserted into the external auditory canal. The patient is prescribed antibiotics in accordance with the results of bacteriological examination. It is necessary to constantly perform "toilet" of the ear and remove infected material from the external auditory canal. If discharge from the ear continues, it is necessary to refer the patient to a specialist.

External otitis. The disease is often observed in people suffering from eczema, seborrheic dermatitis or psoriasis (which is caused by scratches on the skin of the external auditory canal), as well as in people who spend a lot of time in water (their skin of the external auditory canal becomes macerated). This also causes pain in the ear, abundant purulent discharge, often thick. An attempt by a doctor to move the auricle or press on the tragus causes sharp pain. Infected material from the outer ear must be removed (if the inflammation is not too acute, the ear must be carefully washed with a stream from a syringe, but if acute, the ear is cleaned with a cotton swab). These local procedures should be carried out only for a short time, since their long-term use can lead to complications with a fungal infection, which is difficult to cure radically. It is advisable to use antibiotics locally in the form of drops, for example, 0.3% gentamicin solution every 6 hours (sometimes they are used in combination with steroids), they are dripped onto a turunda placed in the external auditory canal, or injected into the ear after cleaning it.

Chronic purulent otitis media. It manifests itself as discharge from the ear and hearing loss in the affected ear without pain. Central perforation of the eardrum indicates that the inflammatory process is localized in the lower anterior part of the middle ear. Treatment should be aimed at drying out the discharge from the ear (frequent ear hygiene, drops with antibiotics and steroids depending on the results of bacteriological examination). Surgical intervention is aimed at restoring the correct connection of the ear bones and eliminating the defect in the eardrum.

Cholesteatoma. This is a layering of squamous epithelial tissue (skin) in the middle ear and in the destroyed structures of the mastoid process (for example, in the labyrinth, in the meningeal membranes, in the facial nerve) with concomitant infection. In this case, the discharge from the ear has an unpleasant odor; perforation of the eardrum often occurs in its posterior or superior part. The patient needs to consult a specialist in order to remove all the affected or infected bone tissue (mastoidectomy, atticotomy, atticoanthrotomy) and thereby save the ear. When the postoperative cavity is connected to the external auditory canal by means of surgery, the discharge from the ear continues until this cavity is covered with skin.

Diagnosis of ear discharge

History. Acute otalgia followed by relief after otorrhea is a sign of acute purulent otitis media (perforative stage). If the patient is fond of swimming or has seborrheic eczema, external otitis should be assumed. Recent head trauma or surgery on the temporal bone indicate the need to exclude cerebrospinal fluid leakage. Perforation of the tympanic membrane or chronic dysfunction of the auditory tube may be indirect signs of cholesteatoma. Mastoiditis may develop if acute otitis media is not treated properly.

Physical examination. Otoscopy may reveal perforation of the eardrum, signs of otitis externa, the presence of a foreign body, or other causes of otorrhea. Clear fluid discharge may indicate cerebrospinal fluid leakage; in trauma, the discharge is often bloody. Floating epidermal scales in the lavage fluid indicate cholesteatoma. Swelling in the parotid region, abundant growth of granulation tissue in the external auditory canal, and facial nerve paralysis may be seen in necrotizing otitis externa. Redness and tenderness of the mastoid process indicate mastoiditis.

Additional studies. If liquorrhea is suspected, the discharge should be tested for the presence of glucose or beta ₂ -transferrin. In the absence of obvious otoscopic signs, audiometry, computed tomography of the temporal bone or visualization by magnetic resonance imaging are performed, and histological examination of the removed granulation tissue is carried out.

To avoid untimely diagnosis of meningitis and other intracranial complications, antibiotic treatment should not be started without complete certainty of the diagnosis.

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Treatment of ear discharge

Treatment depends on the final diagnosis. Antibiotics are prescribed if an infection is present.