Practice ABC of Ear, Nose and Throat, 6th Edition

Discharge from the Ear

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g150 (Published 10 January 2014) Cite this as: BMJ 2014;348:bmj.g150
  1. Robin Youngs
  1. Gloucestershire Royal Hospital, Gloucester, UK

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Overview

  • Discharge from the ear is an unpleasant symptom that in some communities can result in stigmatisation

  • Before an accurate diagnosis can be made, the discharge should be cleared by microsuction or dry-mopping

  • Topical antibiotic/steroid drops are most effective in treating otitis externa

  • Discharge due to chronic otitis media occurs in the presence of a defect in the eardrum

  • Cholesteatoma can be associated with serious complications

Discharge from the ear is an unpleasant symptom that reflects infection, inflammation, trauma or rarely neoplasm of the external or middle ear (Box 1). Persistent ear discharge and its associated odour can result in stigmatisation and social isolation in some communities (Figure 1).

Causes of Discharging Ears

Otitis externa (acute and chronic)

Otitis media (acute and chronic)

Trauma to the temporal bone

Neoplasms of the ear (very rare)

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Figure 1 

Profuse ear discharge.

The discharge itself arises either from the skin of the external ear canal, the surface of the tympanic membrane (eardrum), or the lining of the middle ear cleft (Figure 2). Discharge from the middle ear cleft often is profuse and mucoid in nature, because of the mucosal lining of the middle ear. In the clinical management of a discharging ear, accurate diagnosis is important and is facilitated by thorough history taking and examination. ENT specialists have the advantage of the use of the operating microscope available in the outpatient setting (Figure 3). Using the microscope in combination with suction equipment allows the specialist to aspirate discharge and closely inspect the ear canal and tympanic membrane. In the …

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