Some Causes and Features of Ear Discharge
Cause | Common Features* | Diagnostic Approach |
|---|---|---|
Acute discharge (lasting less than 6 weeks) | ||
Severe ear pain significantly relieved when a thick, whitish discharge starts | Doctor’s examination alone | |
Chronic otitis media (acute flare up) | History of eardrum perforation and/or cholesteatoma (a noncancerous growth of skin cells in the middle ear), and previous discharge Eardrum appears abnormal during doctor's examination | Sometimes doctor’s examination alone Sometimes high-resolution temporal bone CT |
Cerebrospinal fluid leak caused by severe head injury or recent neurosurgery | Obvious recent head injury or neurosurgery Fluid ranges from crystal clear to blood | Imaging studies such as head CT scan including skull base or MRI with gadolinium |
Otitis externa (infectious or allergic) | Infectious: Often after swimming or injury; severe pain, worse with pulling on ear Allergic: Often after use of ear drops; more itching and redness, and less pain than with infectious cause Typically a rash on the earlobe, where discharge trickled out of ear canal Both: Ear canal very red, swollen, and filled with debris; eardrum appears normal | Doctor’s examination alone |
Chronic discharge (lasting more than 6 weeks) | ||
Discharge often bloody, mild pain Sometimes doctor can see a growth in ear canal Typically in older people | Removal and examination (biopsy) of ear tissue Usually CT scan or MRI | |
History of ear infections and typically eardrum perforation and/or cholesteatoma Less pain than with external otitis Eardrum appears abnormal during doctor's examination | Sometimes doctor’s examination alone Usually culture of a sample of the ear discharge If suspected cholesteatoma, MRI | |
Usually in children Drainage foul-smelling, pus-filled (purulent) Foreign object often visible during examination unless visibility blocked by swelling and/or discharge | Doctor’s examination alone | |
Often fever, history of untreated or unresolved otitis media Redness, tenderness over mastoid | Usually a doctor’s examination alone Sometimes CT scan | |
Usually people have an immune deficiency or diabetes Chronic severe pain Swelling and tenderness around ear, abnormal tissue in ear canal Sometimes weakness of facial muscles on affected side | CT scan or MRI Usually culture | |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||