TABLE 9-1. Otorrhea from external ear canal | ||||||||||||||||||||||||||||||||||||||||
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Ear Drainage and Bleeding
Ear Drainage and Bleeding
Rhoda Wynn
Neil M. Sperling
Otorrhea, or drainage from the ear, is a common complaint that could signify an innocuous or potentially lethal condition. Thorough examination including microscopic examination and debridement is indicated to uncover the exact cause. The differential diagnosis of otorrhea depends on whether the otorrhea is from the external auditory canal or the middle ear space or another space that may communicate with the ear canal.
HISTORY AND PHYSICAL EXAMINATION
A complete medical history often leads to the correct diagnosis. The character of the otorrhea (color, consistency, odor) should be determined, as well as duration. The patient should be questioned about associated otologic symptoms such as vertigo, hearing loss, tinnitus, and otalgia. Other relevant history includes ear surgeries, recent upper respiratory infections, use of topical otic medications, recent swimming, head or ear trauma, dermatoses, and diabetes mellitus.
During the physical exam, particular attention should be paid to signs indicating recent trauma, extension of infection into intracranial regions, or change in the level of consciousness. When symptoms are unilateral, the uninvolved ear should be examined first. Look for periauricular or scalp dermatoses, incisions around the ear, protrusion of the ears and tenderness or ecchymosis of the mastoid tip. Check for granulation tissue, skin changes, or edema of the external ear canal. Assess the characteristics (color, consistency, odor, and clarity) of the drainage. Determine the integrity of the tympanic membrane.
DIFFERENTIAL DIAGNOSIS AND TREATMENT
Table 9-1 lists several common causes of otorrhea from the external auditory canal, and Table 9-2 lists causes of otorrhea from the middle ear space.
