Otorrhoea - Ear Discharge

Otorrhoea, or ear discharge, is a sign and symptom of outer and middle ear disease. Inner ear disease does not cause discharge (or ear pain, for that matter).

 

The characteristics of the discharge can give some clues as to the underlying cause. In the table below the character is paired with a diagnosis. Remember that life is seldom so simple and that there is overlap between character and diseases. Nonetheless, these characteristics are beloved of exam setters and clinicians alike.

A patient comes to you with ear discharge...
 
The discharge is caused by disease in the ear canal or in the middle ear. Usually, this will be an infective process. Take a good history and examine the ear as best you can. It may reveal an obvious source for the discharge. 
 
In clinical practice, we will usually start by offering topical medication to the patient. Sampling of the discharge is not necessary at this stage because the infecting organisms are fairly predictable and oto-topical medications work against the majority of them (see otitis media and perforation sections for details).
The patient is reviewed after a few days to assess response to medication. If the condition has not changed a swab for culture and sensitivity will be performed and further antimicrobial management will be based upon the results.
 
Topical ear drops often contain ototoxic antibiotics such as gentamicin or neomycin and there is concern that these may cause permanent hearing loss if they are applied to the ear. In practice, if one follows some simple rules, it is safe to use them:
 
1. Only use when there is infection present
2. Use for ten days only
 
In recent years, topical quinolones have appeared on the market. These are not ototoxic and have a very similar spectrum of activity to the aminoglycosides above.
 
Patients often benefit from aural toilet. Mopping the ear with cotton-wool encourages the discharge to flow out and allows access for medication to reach the infected surface. In some cases the patient will have to be referred for aural suction.