Overview

Otorrhea refers to ear discharge, which is the drainage of fluid from the ear canal. It is a symptom rather than a disease and can indicate a variety of underlying ear conditions, ranging from simple infections to more serious problems like a ruptured eardrum or skull fracture. Otorrhea can present as clear, bloody, purulent (pus-like), or foul-smelling discharge, depending on its cause. Prompt medical evaluation is essential, especially if the discharge is accompanied by other symptoms such as hearing loss, pain, or fever.

Causes

Otorrhea can result from numerous conditions affecting the outer, middle, or inner ear. Common causes include:

• Ear infections: Acute otitis media (middle ear infection) or otitis externa (outer ear infection, also known as swimmer’s ear) are leading causes of ear discharge.
• Tympanic membrane perforation: A ruptured eardrum can lead to fluid or pus leaking from the middle ear.
• Cholesteatoma: A non-cancerous skin growth in the middle ear that can cause chronic, foul-smelling discharge.
• Trauma: Injury to the ear, including insertion of foreign objects, can lead to bleeding or fluid leakage.
• Head injury: Severe trauma or skull fractures can cause cerebrospinal fluid (CSF) to leak from the ear (CSF otorrhea), typically clear and watery.
• Post-surgical drainage: Discharge following ear surgery may occur as part of the healing process.
• Foreign bodies: Objects lodged in the ear canal can cause infection and subsequent discharge.

Symptoms

Otorrhea presents primarily as fluid drainage from the ear, but associated symptoms can provide clues to the underlying cause:

• Type of discharge:
  • Clear and watery – possible CSF leak or early-stage infection.
  • Thick and yellow/green – commonly due to bacterial infection.
  • Bloody – trauma or ruptured eardrum.
  • Foul-smelling – typically associated with chronic infections or cholesteatoma.
• Ear pain (otalgia): Often accompanies infections or trauma.
• Hearing loss: Blockage of the ear canal or damage to ear structures can reduce hearing.
• Fever: May occur in bacterial infections.
• Itching or irritation: Common with outer ear infections or allergic reactions.
• Dizziness or vertigo: Suggests involvement of the inner ear or serious infections.

Diagnosis

Diagnosing the cause of otorrhea involves a thorough clinical examination and, when necessary, additional tests:

• Physical examination: An otoscope is used to inspect the ear canal and eardrum for signs of infection, perforation, or foreign bodies.
• Ear swab and culture: Collecting a sample of the discharge helps identify bacterial or fungal pathogens.
• Audiometry: Hearing tests may be performed if hearing loss is reported.
• Imaging studies: CT or MRI scans are useful in cases of suspected cholesteatoma, skull fracture, or persistent symptoms.
• Beta-2 transferrin test: A specialized test used to confirm cerebrospinal fluid in suspected CSF leaks.

Treatment

Treatment for otorrhea targets the underlying cause and aims to stop the discharge, relieve symptoms, and prevent complications:

• Antibiotics: Oral or topical antibiotics are prescribed for bacterial infections such as otitis externa or otitis media.
• Ear drops: Antifungal or antibiotic ear drops may be used, especially for outer ear infections.
• Ear cleaning (aural toilet): Professional cleaning to remove debris and discharge from the ear canal.
• Pain management: Analgesics like acetaminophen or ibuprofen to relieve pain and reduce inflammation.
• Management of ruptured eardrum: Most heal spontaneously, but persistent perforations may require surgical repair (tympanoplasty).
• Surgery: In cases of cholesteatoma or chronic ear disease, surgical intervention may be necessary to remove abnormal tissue and prevent recurrence.
• CSF leak management: Requires neurosurgical evaluation and may involve bed rest, lumbar drainage, or surgical repair.

Prognosis

The prognosis for otorrhea varies based on its underlying cause:

• Excellent in most infections: With appropriate treatment, most bacterial or fungal ear infections resolve fully.
• Good with treatment for trauma: Tympanic membrane perforations often heal without complications, though monitoring is essential.
• Chronic otorrhea: Conditions like cholesteatoma can cause persistent issues but are manageable with surgery and follow-up care.
• Serious causes: CSF otorrhea or complications from severe infections require urgent care but can have good outcomes with prompt treatment.
• Prevention of recurrence: Proper ear hygiene, avoiding trauma, and managing allergies help prevent future episodes of otorrhea.

Most cases of otorrhea respond well to treatment, and with early diagnosis, long-term complications can be avoided.