Some Causes of Otorrhea
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Acute discharge* | ||
Acute otitis media with perforated TM | Severe pain, with relief on appearance of purulent discharge | History and physical examination Sometimes audiogram Sometimes high-resolution temporal bone CT if a complication of acute otitis media (eg, subperiosteal abscess, new onset vertigo or dizziness, facial nerve weakness/paralysis) is suspected |
Otorrhea in patients with chronic perforation, sometimes with cholesteatoma Can also manifest as chronic discharge | Sometimes history and physical examination alone Sometimes high-resolution temporal bone CT Sometimes audiogram | |
Significant, clinically obvious head injury or recent surgery Fluid ranges from crystal clear to pure blood | High-resolution CT of the brain and skull base MRI | |
Otitis externa (infectious or allergic) | Infectious: Often after swimming, local trauma; marked pain, worse with ear traction Often a history of chronic ear dermatitis with itching and skin changes Allergic (contact dermatitis): Often after use of ear drops; more itching, erythema, less pain than with infectious Typically involvement of earlobe, where drops trickled out of ear canal Both: Canal very edematous, inflamed, with debris; normal TM | History and physical examination alone |
Post-tympanostomy tube | After tympanostomy tube placement May occur with water exposure | History and physical examination alone |
Chronic discharge | ||
Discharge often bloody, mild pain Sometimes visible lesion in canal Easy to confuse with otitis externa early on | Biopsy CT MRI in some cases | |
History of TM perforation Flaky squamous debris in ear canal (dead skin), retraction pocket in TM filled with keratin debris or dead skin Sometimes polypoid mass or granulation tissue over the cholesteatoma | CT Culture Sometimes diffusion weighted MRI to assess extension into the mastoid or intracranial extension | |
Long history of ear infections or other ear disorders Less pain than with external otitis Canal macerated, granulation tissue TM immobile, distorted, usually visible perforation | Sometimes history and physical examination alone Usually culture | |
Usually in children Drainage foul-smelling, purulent Foreign body often visible on examination unless marked edema or drainage | History and physical examination alone | |
Often fever, history of untreated or unresolved otitis media Redness, tenderness over mastoid | CT with contrast | |
Usually history of immune deficiency or diabetes Chronic severe pain Periauricular swelling and tenderness, granulation tissue in ear canal Sometimes facial nerve paralysis or dysfunction of other cranial nerves (9, 10, 11, 12) | CT and MRI are complementary and are recommended Sometimes radionuclide studies (eg,technetium-99 and gallium scans) Culture | |
Often with respiratory tract symptoms, chronic rhinorrhea, arthralgias, and oral ulcers | Urinalysis Chest radiograph Antineutrophilic cytoplasmic antibody testing Biopsy Nasolaryngoscopy to assess for other commonly affected sites (eg, septum, subglottis) | |
* < 6 weeks | ||
CSF=cerebrospinal fluid; CT = computed tomography; MRI = magnetic resonance imaging; TM = tympanic membrane. | ||