Деякі причини виділень із вуха
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Acute discharge* | ||
Acute otitis media with perforated TM | Severe pain, with relief on appearance of purulent discharge | Clinical examination alone |
Otorrhea in patients with chronic perforation, sometimes with cholesteatoma Can also manifest as chronic discharge | Sometimes clinical examination alone Sometimes high-resolution temporal bone CT Sometimes audiogram | |
Significant, clinically obvious head injury or recent surgery Fluid ranges from crystal clear to pure blood | Head CT, including skull base | |
Otitis externa (infectious or allergic) | Infectious: Often after swimming, local trauma; marked pain, worse with ear traction Often a history of chronic ear dermatitis with itching and skin changes Allergic: Often after use of ear drops; more itching, erythema, less pain than with infectious Typically involvement of earlobe, where drops trickled out of ear canal Both: Canal very edematous, inflamed, with debris; normal TM | Clinical examination alone |
Post-tympanostomy tube | After tympanostomy tube placement May occur with water exposure | Clinical examination alone |
Chronic discharge | ||
Discharge often bloody, mild pain Sometimes visible lesion in canal Easy to confuse with otitis externa early on | Biopsy CT MRI in some cases | |
History of TM perforation Flaky debris in ear canal, pocket in TM filled with caseous debris Sometimes polypoid mass or granulation tissue over the cholesteatoma | CT Culture Sometimes diffusion weighted imaging (or CT) to assess extension into the mastoid or intracranial extension | |
Long history of ear infections or other ear disorders Less pain than with external otitis Canal macerated, granulation tissue TM immobile, distorted, usually visible perforation | Sometimes clinical examination alone Usually culture | |
Usually in children Drainage foul-smelling, purulent Foreign body often visible on examination unless marked edema or drainage | Clinical examination alone | |
Often fever, history of untreated or unresolved otitis media Redness, tenderness over mastoid | CT | |
Usually history of immune deficiency or diabetes Chronic severe pain Periauricular swelling and tenderness, granulation tissue in ear canal Sometimes facial nerve paralysis | CT or MRI Culture | |
Granulomatosis with polyangiitis (formerly Wegener granulomatosis) | Often with respiratory tract symptoms, chronic rhinorrhea, arthralgias, and oral ulcers | Urinalysis Chest x-ray Antineutrophilic cytoplasmic antibody testing Biopsy |
* < 6 weeks CSF=cerebrospinal fluid; TM = tympanic membrane. | ||