12 Purulent Otorrhea Purulent otorrhea may be the result of a variety of pathologies arising in the ear canal or middle ear. Although most of these causes are primarily due to an acute or chronic infectious problem, they may rarely be secondary to a more worrisome clinical entity, such as a tumor. As a result, a thorough investigation of the patient with purulent otorrhea is always warranted. See Chapter 10 for a discussion of purulent otorrhea resulting from a foreign body in the external auditory canal. Eczema, psoriasis, and seborrheic dermatitis are dermatologic conditions of the ear canal. Affected patients are often at risk for similar dermatitis on other parts of the body, although the ear canal may be the only region affected. Presenting symptoms are chronic aural pruritis, otorrhea, and, at times, otalgia. The ear canal skin may appear dry and flaky, and the external auditory meatus often appears thickened and narrowed. There can be acute bacterial otitis externa secondary to skin breakdown. There is often a complete absence of cerumen. If the cause is a contact dermatitis from the use of ear drops, then you may see a reddish streak along the front of the pinna, to the lobule, and onto the neck, where drops have drained out the ear. Otitis externa is a common cause of purulent otorrhea and otalgia, and, at times, hearing loss. Examination reveals purulent otorrhea alone or, in the case of otomycosis, admixed with characteristic fungal hyphae. The otorrhea may be sent for culture, but regardless, it should be suctioned. This reveals edematous and erythematous external auditory canal skin with a normal-appearing tympanic membrane. The infections may be acute or chronic.
External Auditory Canal Origin
External Auditory Canal Foreign Body
Noninfectious Otitis Externa: Eczema, Psoriasis, and Seborrheic Dermatitis
Infectious Otitis Externa: Bacterial, Fungal, or Atypical Mycobacterium
Radiation-Induced Chronic Otitis Externa
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