Intended for healthcare professionals

Practice 10-Minute Consultation


BMJ 2011; 342 doi: (Published 20 May 2011) Cite this as: BMJ 2011;342:d2299
  1. Miran Pankhania, specialist trainee year one in otolaryngology1,
  2. Owen Judd, specialist registrar in otolaryngology2,
  3. Andy Ward, general practitioner3
  1. 1Department of ENT, Milton Keynes General Hospital, Milton Keynes MK6 5LD, UK
  2. 2Department of ENT, Leicester Royal Infirmary, Leicester LE1 5WW, UK
  3. 3South Wigston Health Centre, Leicester LE18 4SE
  1. Correspondence to: M Pankhania pank{at}
  • Accepted 28 February 2011

A 49 year old woman presents to her general practitioner with discharge from her left ear and otalgia. She had used olive oil drops for ear wax and completed a course of amoxicillin for presumed otitis media. Her symptoms have persisted despite treatment.

What you should cover

Ask about :

  • Otorrhoea

  • Otalgia

  • Tinnitus

  • Vertigo

  • Hearing loss

Most ear disorders will present with one or more of these five symptoms.

What is the link between otorrhoea and otalgia?

Otitis externa presents with pain and discharge simultaneously. Patients with acute otitis media present with increasing otalgia. Otorrhoea starts when the tympanic membrane perforates, which resolves the earache. Acute otitis media is more common in children than in adults. Both otitis externa and acute otitis media carry a risk of intracranial disease if inappropriately treated.1 2 Secondary symptoms such as headache, diplopia, pyrexia, neurology, and unrelenting pain indicate the need for more aggressive management.

Risk factors

Psoriasis, eczema, previous otitis externa or otitis media, and ear surgery all increase the chance of future ear disease. The patient’s hobbies, occupation, and activities provide insight into potential ear disease, in particular:

  • Water exposure: canal abnormalities and otitis externa

  • Use of ear defenders, hearing aids, or headphones: otitis externa

  • Flying: barotrauma and perforation

  • Diabetes or immunodeficiency: necrotising otitis externa

  • Use of cotton buds: many patients use these to try to remove wax from the ear

  • “Hopi” candles: some patients use these to try to remove wax from the ear.

Prevalence and incidence

  • 10% of people have otitis externa at some point in life. …

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