Otorrhea

Otorrhea is discharge from the external auditory canal. The fluid may be serous, mucopurulent, bloody, or foul-smelling and can be unilateral or bilateral. The most common causes are infectious, especially acute otitis externa (infection of the outer ear canal) and chronic suppurative otitis media after tympanic membrane perforation. Other etiologies include trauma or foreign body, cerumen impaction, allergic or inflammatory dermatitis of the canal, cholesteatoma, and, less commonly, neoplasms.

Symptoms and signs vary with the cause but commonly include ear discharge, ear fullness or itching, pain (more typical with acute otitis externa), hearing loss, and sometimes fever or vertigo. An examination with otoscopy helps determine whether the tympanic membrane is intact, perforated, or eroded, and whether the canal is inflamed or blocked by debris.

Evaluation may involve additional tests such as tympanometry or audiometry if hearing loss is present, and culture or Gram stain of the discharge in cases of persistent or severe infection. Imaging, such as CT or MRI, is reserved for suspected complications like mastoiditis or cholesteatoma.

Management is etiologic. Acute otitis externa is usually treated with topical antibiotics, with or without a topical steroid, and measures to keep the ear dry. In cases of tympanic membrane perforation or chronic suppurative otitis media, non-ototoxic antibiotic drops (for example, fluoroquinolones) are preferred, and systemic antibiotics may be needed for spreading infection or complications. Cholesteatoma and malignant otitis externa require prompt ENT evaluation, with possible surgical management. Prevention focuses on keeping the ear dry, avoiding insertion of objects, and treating dermatitis or infections promptly.