Otorrhea
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Ear discharge caused by an irritation or inflamed tissue within the mastoid, ear canal or middle ear.
Pathophysiology
When the middle ear becomes acutely infected by bacteria, pressure builds up behind the ear drum, usually but not always causing pain. In severe or untreated cases, the tympanic membrane may rupture, allowing the pus in the middle ear space to drain into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a traumatic process, it is almost always associated with the dramatic relief of pressure and pain.
Physical examination technique
To determine the cause of the otorrhea, it is necessary to clean the ear, preferably via suction. In the event that otorrhea is present, do not utilize ear lavage due to the potential risk of injury. Cerebrospinal fluid otorrhea should always be measured in the event there was face or head trauma/surgery.
Instead of the infection and eardrum perforation resolving, however, drainage from the middle ear can become a chronic condition. As long as there is active middle ear infection, the eardrum will not heal. The World Health Organization defines Chronic Serous Otitis Media (CSOM) as 'a stage of ear disease in which there is chronic infection of the middle ear cleft, a non-intact tympanic membrane (i.e. perforated eardrum) and discharge (otorrhoea), for at least the preceding two weeks' (WHO 1998). (Notice WHO's use of the term "serous" to denote a bacterial process, whereas the same term is generally used by ear physicians in the United States to denote simple fluid collection within the middle ear behind an intact eardrum. "Chronic otitis media" is the term used by most ear physicians worldwide to describe a chronically infected middle ear with eardrum perforation.)
Differential Diagnosis of Causes
In alphabetical order. [1] [2]
- Cerebrospinal fluid otorrhea
- Cholesteatoma
- Foreign body
- Malignant otitis externa
- Mastoiditis
- Otitis media with perforated tympanic membrane
- Swimmers ear (Otits externa)
Ear Nose and Throat
- Cleaning the ear thoroughly with magnification
- If no tymanic membrane, then the source is the external ear canal
MRI and CT
- CT of temporal bones for cholesteatoma, mastoiditis and CSF otorrhea
Other Diagnostic Studies
- CSF otorrhea:
- beta 2 trasferrin to identify CSF
Treatment
Foreign bodies can be removed with alligator forcieps under magnification. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the infection and the ear drum nearly always heals. Antibiotic administration can prevent perforation of the eardrum and hasten recovery of the ear.
Pharmacotherapy
Acute Pharmacotherapies
- Antibiotic drops
- Topical antifungal