Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus (purulent). Depending on the cause of the discharge, people may also have ear pain Earache Earache usually occurs in only one ear. Some people also have ear discharge or, rarely, hearing loss. Ear pain may be due to a disorder within the ear itself or a disorder in a nearby body part... read more , fever, itching, vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness (feeling about to pass out) Light-headedness Dysequilibrium (feeling off balance or... read more , ringing in the ear (tinnitus Ear Ringing or Buzzing Ringing in the ears (tinnitus) is noise originating in the ear rather than in the environment. It is a symptom and not a specific disease. Tinnitus is very common—10 to 15% of people experience... read more ), and/or hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more . Symptoms range from sudden and severe to slowly developing and mild.
Causes of Ear Discharge
Discharge may originate from the ear canal, the middle ear, or, rarely, from inside the skull.
Overall, the most common causes of ear discharge are
Acute (sudden and severe) middle ear infection (otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear. Acute otitis media often occurs in people with a cold or allergies. The infected ear is painful. Doctors examine the eardrum... read more ) with perforation (puncture Eardrum Perforation A perforation is a hole in the eardrum. Eardrum perforations are caused by middle ear infections and injuries. Perforation causes sudden ear pain, sometimes with bleeding from the ear, hearing... read more ) of the eardrum
Chronic otitis media Otitis Media (Chronic Suppurative) Chronic suppurative otitis media is a long-standing, persistently draining perforation of the eardrum (tympanic membrane). Acute otitis media and blockage of a eustachian tube are among the... read more (with perforation of the eardrum, cholesteatoma, or both)
In some people with otitis media (usually children), the eardrum ruptures, releasing the infected material collected behind the eardrum. The hole in the eardrum almost always heals, but sometimes a small perforation remains. A perforation may also result from injury or surgery to the eardrum. When a perforation is present, people are at risk of chronic middle ear infections, which can cause ear discharge.
Serious, but rare, causes of ear discharge include
Cholesteatoma (a noncancerous growth of white skinlike material in the middle ear)
The ear canal passes through the base of the skull. If a skull fracture (from a severe head injury) involves that part of the skull, blood and/or cerebrospinal fluid may leak from the ear.
Necrotizing, or malignant, external otitis is a particularly severe form of external ear infection that typically occurs only in people with diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more or those who have a compromised immune system (due to HIV Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS). HIV is transmitted... read more infection or chemotherapy for cancer Chemotherapy Chemotherapy involves the use of drugs to destroy cancer cells. Although an ideal drug would destroy cancer cells without harming normal cells, most drugs are not that selective. Instead, drugs... read more ) .
Some people with chronic otitis media develop a noncancerous (benign) growth of skin cells in the middle ear (cholesteatoma Otitis Media (Chronic Suppurative) Chronic suppurative otitis media is a long-standing, persistently draining perforation of the eardrum (tympanic membrane). Acute otitis media and blockage of a eustachian tube are among the... read more ) that can cause discharge. Although a cholesteatoma is noncancerous, it can cause significant damage to the ear and nearby structures. In severe cases, a cholesteatoma may lead to deafness, facial weakness or paralysis, and complications with the brain such as an abscess and other infections.
Evaluation of Ear Discharge
The following information can help people with ear discharge decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.
In people with ear discharge, certain symptoms and characteristics are cause for concern:
Recent major head injury
Any neurologic symptoms (such as vertigo or difficulty seeing, speaking, swallowing, and/or talking)
Hearing loss in the affected ear
Redness and/or swelling of the ear or area around the ear
Diabetes or a compromised immune system
When to see a doctor
People with warning signs should see a doctor right away. People without warning signs should see a doctor as soon as possible and avoid getting water in the ear until it can be evaluated.
What the doctor does
In people with ear discharge, doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the ear discharge and the tests that may need to be done (see table Some Causes and Features of Ear Discharge Some Causes and Features of Ear Discharge Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus (purulent). Depending on the cause of the discharge, people may also have... read more ).
During the medical history, doctors ask about the following:
Activities that can affect the ear canal or eardrum (for example, swimming; insertion of objects, including cotton swabs; and use of ear drops)
Whether people have had repeated ear infections
Any severe head injury
During the physical examination, doctors focus on examining the ears, nose, throat, and neurologic system. By examining the ear canal with a light, doctors can usually diagnose perforated eardrum Eardrum Perforation A perforation is a hole in the eardrum. Eardrum perforations are caused by middle ear infections and injuries. Perforation causes sudden ear pain, sometimes with bleeding from the ear, hearing... read more , external otitis Ear Canal Infection (Swimmer's Ear) Bacteria and sometimes fungi can cause acute infection of the skin of the ear canal. Ear canal infection is caused by bacteria or, less commonly, fungi. Typical symptoms are pain and discharge... read more , foreign object Objects in the Ear Objects in the ear can be removed by flushing the ear canal with sterile water or saline or using suction, forceps, or other tools. If the foreign body cannot easily be removed, a referral to... read more , and other common causes of ear discharge. Other findings suggest the diagnosis.
Many causes of ear discharge are clear after the doctor's examination. Possible tests include
CT or MRI
If the cause is not clear, doctors usually do a formal hearing test (audiometry Testing Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more ) and computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (CT) or gadolinium-enhanced magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI). If abnormal tissue is present in the ear canal, a tissue sample (biopsy) may be taken. Sometimes culture swabs are taken of the drainage to identify infection.
Treatment of Ear Discharge
Treatment for ear discharge is directed at the cause. People who have a large perforation of the eardrum are advised to keep water out of the ear. People can keep water out of the ear while showering or washing their hair by coating a cotton ball with petroleum jelly and placing it at the opening of the ear canal. Doctors can also make plugs out of silicone and place them in the canal. Such plugs are carefully sized and shaped so that they do not get lodged deep in the ear canal and cannot be removed. People who have a small perforation, such as that caused by a ventilation tube, should ask a doctor whether they need to keep water out of the ear. A cholesteatoma is treated surgically.
Key Points about Ear Discharge
Acute discharge in people without longstanding ear problems or a weakened immune system is usually not dangerous and is typically due to an external ear infection or a perforated eardrum resulting from a middle ear infection.
People who have chronic ear symptoms or any symptoms besides ear discharge (particularly any neurologic symptoms) should be evaluated by a specialist.