Ear discharge

Ear discharge
Ear discharge/otorrhea- drainage
exciting the ear
May be purulent, watery, mucoid,
foul-smelling

Character of otorrhea

Etiology

Watery

Ezcema of ear canal,

Cerebrospinal fluid(CSF)

Purulent

Acute otitis externa eg

furunculosis

Mucoid

Chronic otitis
media(tubotympanic) with a
perforation

Mucopurulent/ + blood stain

Trauma, acute otitis media,

carcinoma of the ear

Foul-smelling

Chronic suppurative otitis

media(anticoantral) with
cholesteatoma

 Associated symptom
- otalgia
-fever
-pruritus
-vertigo
-tinnitus
-hearing loss

Causes of ear discharge

External ear
- Otitis externa
Middle ear
-Acute Otitis Media(AOM)
-Chronic Supurrative Otits Media
-Mastoiditis
-Temporal bone fracture

1. Otitis Externa
INFLAMMATION/INFECTION of the
EAM
All age group
Bateria(~90%): Pseudomonas aeruginosa, E.coli,
S. aureus

Diffuse otitis externa

Diffuse imflammation of the skin of
EAM
Predisposing factor:
-

Swimming
Aggressive scratching / self cleaning
Ear wash with non-sterile water
Humid, hot climate
Diabetes???

Signs and symtoms

- Otalgia
- Itching (esp in fungal OE and chronic
OE)
- Ear fullness
- Hearing loss
- Discharge- clearpurulent, foul
smelling
- Tenderness of tragus/pinna
- Ear edema/erythema

Furunculosis
An acute localized inflammation of a
hair follicle by staphylococcus
organism in the outer cartilaginous
part of EAM.
Complaint of
-severe pain
-aural fullness
-hearing loss

Otomycosis
Fungal infection of EAM
Causative agents-Aspergillus niger, Candida albicans
Symptoms
-itching*usually no discharge!!!
-discomfort/pain
-ear blockage

Causes
- frequent use of local ear antibiotic
-local trauma
- hot climate
- swimming ( swimmers ear)

Treatment of otitis externa

Aural toilet
- remove debris and exudate
- either dry mopping, suction clearance, irrigating with warm, sterile
normal saline
Medical treatment:
-Analgesia eg. (lidocaine and prilocaine)
-Steroid- to reduce edema and otalgia eg dexamethasone
-Antibiotic- ofloxacin, ciprofloxacin, Polymyxin B and neomycin ( for
Staph Aerus and P. Aeruginosa), systemic antibiotics (if spread
beyond EAC)
-Anti-fungal- Itraconazole, clotromazole * + repeated debridement
Meatoplasty- surgical enlargement of cartilaginous if canal obstruction
Prevention of recurrence- keep ear dry, strict water protection of the
affected ear for 10-14 days, silicone rubber ear plugs if need to swim,
avoid scratching

1. Acute otitis media

Presentation:
Age 18months -6 years
Triad of otalgia, fever, hearing loss
Mucopurulent/blood-stained
discharge
Pathogenesis:
-Obstruction of ET ve
intratympanic
pressure(irritant)
edema of mucosa
with exudate
infection of exudate

Treatment
Early:
Antibiotics-Amoxycilin
Analgesia-paracetamol
Myringotomy - necessary when TM is buldging
Education (keep dry, avoid air travel)
Complication:
Otologic : TM perforation, CSOM, ossicular necrosis,
hearing loss
CNS : meningitis, facial nerve palsy, brain abscess
Mastoiditis

2. Chronic Supurrative otitis

media
Characterized by ear discharge and
permanent perforation.
2 types:
-Tubotympanic type
-Cholesteatoma type

a)Chronic Suppurative Otitis Media

with Perforation (Tubotympanic type)
Presentation:
When AOM persist, persistent
perforation, recurrent AOM
Mucoid discharge (active)
Associated with hearing loss
Affect pars tensa (anterior
inferior)

Treatment
Aural toilet
Topical antibiotics and steroid
eardrops
Graft using temporalis fascia
(myringoplasty)
Education

b)Chronic Suppurative Otitis Media

with Cholesteatoma (Atticoantral type)
Presentation:
Foul smelling
Life-threatening (invasive), osteitis, ossicular
necrosis
Affect pars flaccida
(posterior superior)
Aetiology:
Long standing
eustachian tube
dysfunction

Treatment
Surgery

Mastoiditis
Presentation:
Associated with AOM
Classic triad -- Tenderness to
pressure, retroauricular swelling
with protruding ear, Mucopurulent
discharge
fever, conductive hearing loss
Associated with progressive facial
paralysis
CT findings : opacification of
mastoid air cell, interuption of
normal trabeculations of cells

Treatment
IV Abx with myringotomy
cortical mastoidectomy( debridement of
infected tissue)
Complication:
Cosmetic deformity, hearing loss, facial
nerve palsy, osteomyelitis, intracranial
extension
If chronic, predispose to carcinoma (bloody
discharge as red flag)

Fracture of temporal bone

Presentation:
CSF otorrhoea, bleeding
Associated with conductive or sensorineural
hearing loss or both.
Facial nerve, carotid artery, jugular vein can be
affected.
Management:
Approach by using ATLS
Otorrhoea resolves spontaneously
Systemic antibiotics are needed