Ear Discharge

20.2.2023
Ear Discharge

• Wax (Normal)

• Pus

• Mucous

• Blood

• CSF

• Saliva
Ear Discharge
Otorrhoea

• an aural discharge

• may arise from disease of ear canal,

• but is more commonly associated with middle ear infections.

• Patient with otorrhoea usually have a degree of hearing loss.

Characteristics of Otorrhoea in relation to aetiology

• Character of otorrhoea • Potential aetiology

1. Watery 1. Eczema of EAC, CSF(rare)

2. Purulent 2. Acute Otitis Externa, Furunculosis

3. Mucoid 3. CSOM with a perforation

4. Mucopurulent/Bloody 4. Trauma, AOM, Carcinoma of ear(rare)

5. Foul smelling 5. CSOM with cholesteatoma

Otorrhoea from ear cannel disease

1. Acute Otitis Externa

2. Chronic Otitis Externa

3. Furunculosis
1. Acute Otitis Externa

• Common in patients with eczematous ear cannel skin

• trauma with cotton buds

• ear cannel infections (in early stage, cannel is red & tender and there may be a
thin discharge.

• Hearing loss occurs later with oedema of the cannel and accumulation of debris.
Acute otitis externa
2. Chronic Otitis Externa
• is may be bilateral, painless, and tends to relapse.

• Skin of the cannel is thickened and easily traumatized.

• Cannel debris should be removed and skin kept dry.

• there may predispose to fungal infection.

Chronic Otitis Externa
3. Furunculosis

• Produces persistent throbbing pain

• a seropurulent otorrhoea if abscess ruptures.

• Patient may require an anaesthetic for drainage..

Furunculosis
Otorrhoea from middle ear disease

1. Safe CSOM( tubotympanic disease)

2. Un-safe CSOM( atticoantral disease)

3. Discharging mastoid cavities

4. Fracture of temporal bone

Safe CSOM ( Tubotympanic Disease)
1. Safe CSOM ( Tubotympanic Disease)

• Rupture of tympanic membrane in acute otitis media produces a bloodstained,

mucopurulent otorrhoea.

• The eardrum usually heals quickly, but if the inflammation persists and the
eardrum skin fails to heal over the margins of the rupture, a persistent perforation
will result.

• Persistent or recurrent mucoid discharge may occur, especially if water enters the
middle ear or in episodes of upper respiratory tract infections.
• Perforations as a result of recurrent acute otitis media usually occurs in pars tensa
and do not involve the annulus.

• Rarely associated with serious disease and referred to as a safe perforation.

• The initial treatment of a discharging perforation is aural toilet combined with

topical steroid eardrops.

• If the perforation persists, the patient has chronic suppurative otitis

media( tubotympanic type), which may be inactive or active.
2. Un-safe CSOM( atticoantral disease)

• Long-standing Eustachian tube dysfunction may produce retraction and

perforation of the tympanic membrane in the attic region or may involve the
annulus.

• Are associated with cholesteatoma( keratinizing epithelium in the middle ear)

• This is a destructive disease and can be life-threatening owing to the potential

complication.
Un-safe CSOM( atticoantral disease) with cholesteatoma
• Aural discharge may be scanty, but offensive because of underlying osteitis.

• Bone destruction may occur toward the middle or posterior cranial fossa, often
unrecognized until an intracranial complication occurs.

• The hearing loss with atticoantral disease is usually marked.

• Surgery is invariably recommended because of the dangerous nature of this

disease.
3. Discharging mastoid cavities

• Many patients have either persistent or recurrent otorrhoea from surgically created
mastoid cavities.

• Uncontrolled infection of the middle ear or mastoid cavities may over many years
predispose to carcinoma.

• This rare complication is heralded by a change in character of otorrhoea from

mucopurulent to bloody.
Fracture of temporal bone
4. Fracture of temporal bone

• A severe blow to the temporal or parietal region may result in a fracture of the
temporal bone.

• Cerebrospinal fluid otorrhoea may occur but usually settles spontaneously.

• Conductive hearing loss is due to a combination of blood in the middle ear,

ossicular disruption, and tympanic membrane perforation.

• Sensorineural hearing loss will result if the fracture passes through the cochlea.
Complication of discharge ear

• Deafness

• Extracranial Intra temporal complication

• Extracranial complication

• Intra cranial complication

• Facial nerve paralysis

• Lateral sinus thrombosis

Management

•Aural toilet

•Topical antibiotics – CSOM

•Systemic antibiotics – ASOM / AOM

•Resistant cases / unsafe - surgery