Introduction

Otorrhea is a common condition characterised by fluid discharge from the ear. The type of otorrhea depends on the characteristics of the fluid discharged from the ear. 

 Types of otorrhea

• Pus-containing
• Serum-containing 
• Bloody
• Mucus-containing 
• Clear

Otorrhea can result from many disorders, including otitis externa, otitis media, cholesteatoma, a ruptured eardrum, and objects stuck in the ear. Depending on the cause of the condition, otorrhea can be a short-term or long-term condition.

Commonly otorrhea is accompanied by pain, itching, and a ringing sensation in the ear. 

A physical examination is typically the sole technique to diagnose otorrhea, but other tests are sometimes employed. Treatment of the condition can vary depending on the cause, with treatment sometimes not being necessary.^1,2

Causes of otorrhea

Otorrhea can be caused by many different diseases. Key among the causes of otorrhea are otitis externa, otitis media, cholesteatoma, a ruptured eardrum, and objects stuck in the ear:^1,2

• Otitis externa: is inflammation of the outer parts of the ear along with otorrhea,  redness, swelling, and pain when the ear is moved are also present^1,2
• Otitis media:  is inflammation of the middle parts of the ear. It is only a cause of otorrhea when the eardrum ruptures.  When otorrhea occurs the fluid discharged from the ear has pus or mucus and may have blood^1,2,3
• Cholesteatoma: Cholesteatoma is caused by the buildup of keratin in the middle ear which can cause other structures within the ear to become damaged and infected.  In cholesteatoma, the fluid discharged from the ear in small quantities has a foul smell and is accompanied by  hearing loss^1,2
• Ruptured eardrum: A ruptured eardrum, also known as a tympanic membrane perforation, is where the eardrum, which separates the outer and middle parts of the ear, tears. Infection, trauma, or sudden changes in the pressure of the ear can cause the eardrum to rupture, potentially leading to pain,  a ringing sensation of the ear, and vertigo, as well as otorrhea^2,4
• Objects stuck in the ear: Sometimes, cotton buds or insects get stuck in the ear. Children often insert objects into their ears. Otorrhea can subsequently occur as the object stuck in the ear can damage structures within the ear, such as the eardrum^2,5

Signs and symptoms of otorrhea

Otorrhea predominantly presents as the discharge of fluid from the ear. The otorrhea can be pus-containing, serum-containing, bloody, or mucus-containing, and even clear. Furthermore, this fluid can be odourless or foul-smelling. It also may be thin or thick in consistency. The colour can vary from clear to green or yellow. Accompanying the discharge of fluid from the ear may be several other signs and symptoms:²

• Ear pain
• Itchiness in the ear
• A ringing sensation in the ear
• Fever
• Redness of the ear
• Hearing loss
• Vertigo
• Difficulty swallowing, speaking, or seeing

Diagnosis of otorrhea

In most cases, a physical examination confirms otorrhea. However, sometimes other techniques are employed to diagnose the condition, including audiometry, imaging techniques, and a culture.²

Physical examination

During a physical examination, a physician examines for any visible abnormalities. In the case of otorrhea, there are several features a physician may be inspecting during a physical examination:^2,6

• Temperature, even if you do not have a fever 
• The ear canal for drainage,  infection, and the eardrum rupture
• Swelling in the ear, jaw, and neck
• Skin for redness or swelling

Audiometry

Audiometry is a test that measures how well you hear by emission of sound waves with varying frequencies. It determines the frequency at which someone can no longer hear these sound waves.   Audiogram indicates the patient’s hearing loss and the type of hearing loss they have based on what part of the ear is impacted.^2,7

Imaging techniques

Imaging techniques can be used to help identify the cause of otorrhea. 

Computed tomography, indicates whether otorrhea has resulted from an ear infection and how far this infection has spread. 

Magnetic resonance imaging determines whether physical trauma to the head has caused a cerebrospinal fluid leak into the ear and caused otorrhea.²

Computed tomography, commonly called a CT scan, uses a circular scanner to take images of the inside of your body as you lie on a bed through the scanner. During this procedure, you may have to breathe in, breathe out, or hold your breath. This procedure takes 10 to 20 minutes to complete.

Magnetic resonance imaging, often called an MRI scan, uses magnets and radio waves to create images of the inside of your body. During magnetic resonance imaging, you lie on a bed that moves through a surrounding circular scanner that contains magnets. An electric current passes through these magnets and produces a loud tapping noise, though headphones block this out. These magnets can cause protons in the body to align. Radio waves can then unalign these protons, and as protons behave differently in different types of tissue, detecting how protons move allows constructing a detailed image of the inside of the body. If you have metal implants, such as a pacemaker or prosthesis, it is unsafe to undergo magnetic resonance imaging. It is best to consult your physician if you believe this applies to you.

Culture 

Culture involves collecting the fluid discharged from the ear to examine a possible infection. This sample is added to the culture medium that permits the bacteria to multiply. Cultures help to determine what bacteria is causing an infection. It is a confirmatory test in the diagnosis of otorrhea as infections of the ear can cause the condition.^2,8

Treatment of otorrhea

The treatment of otorrhea depends on the disease that is causing the condition. Otitis media may be treated with antibiotics whereas, otitis externa with ear drops. A ruptured eardrum often heals on its own within a few weeks; sometimes surgery is required to fix the tear in the eardrum. A physician known as an otolaryngologist specialises in conditions impacting the ears, nose, and throat and can help identify what treatment is most suitable for you.^1,2

FAQ’s

Is otorrhea contagious?

Otorrhea is not contagious.²

Can otorrhea occur in children and adults?

Otorrhea can occur in children and adults. However, the condition is most common in children.²

When should someone seek medical attention for otorrhea?

If you are experiencing otorrhea after an injury then it is important to seek emergency medical care. When experiencing difficulty swallowing, speaking, or seeing warrants one to seek medical care immediately.²

Are there any ways in which otorrhea can be prevented?

Otorrhea is not preventable. However, for those who repeatedly experience otitis externa, using earplugs when bathing or swimming can help prevent it.²

Summary

Otorrhea is fluid discharge from the ear and occurs due to many diseases. The fluid discharged from the ear varies in composition. It may contain pus, blood, and mucus. Otorrhea may be a short-term or long-term condition associated with ear pain, itching, and a ringing sensation of the ear accompanied by more severe signs and symptoms. The otorrhea is diagnosed by physical examination. Treatment of this condition depends on its cause, though not always necessary.