Merck Manual

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Some Causes and Features of Ear Discharge

Some Causes and Features of Ear Discharge

Cause

Common Features*

Diagnosis†

Acute discharge (lasting less than 6 weeks)

Severe ear pain significantly relieved when a thick, whitish discharge starts

A doctor's examination

Chronic otitis media (acute flare up)

History of eardrum perforation and/or cholesteatoma (a noncancerous growth of skin cells in the middle ear), and previous discharge

Eardrum appears abnormal during doctor's examination

A doctor's examination

Sometimes high-resolution temporal bone CT scan

Cerebrospinal fluid leak caused by severe head injury or recent neurosurgery

Obvious recent head injury or neurosurgery

Fluid ranges from crystal clear to blood

Imaging studies such as head CT including skull base or MRI with gadolinium

Otitis externa (infectious or allergic)

Infectious: Often after swimming or injury; severe pain, worse with pulling on ear

Allergic: Often after use of ear drops; more itching and redness, and less pain than with infectious cause

Typically a rash on the earlobe, where drops trickled out of ear canal

Both: Ear canal very red, swollen, and filled with debris; eardrum appears normal

A doctor's examination

Chronic discharge (lasting more than 6 weeks)

Discharge often bloody, mild pain

Sometimes doctor can see a growth in ear canal

Typically in older people

Removal and examination (biopsy) of ear tissue

Usually CT or MRI

History of ear infections and typically eardrum perforation and/or cholesteatoma

Less pain than with external otitis

Eardrum appears abnormal during doctor's examination

A doctor's examination

Usually growth and examination of a sample of the ear discharge (culture)

Usually in children

Drainage foul-smelling, pus-filled (purulent)

Foreign object often visible during examination unless visibility blocked by swelling and/or discharge

A doctor's examination

Often fever, history of untreated or unresolved otitis media

Redness, tenderness over mastoid

A doctor's examination

Sometimes CT

Usually people have an immune deficiency or diabetes

Chronic severe pain

Swelling and tenderness around ear, abnormal tissue in ear canal

Sometimes weakness of facial muscles on affected side

CT or MRI

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† Although a doctor's examination is always done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination, without any testing. In other words, additional tests may not be needed.

CT = computed tomography; MRI = magnetic resonance imaging.