Ear Infection

Ear discharge is a common problem and can be caused by a variety of different pathologies.  Associated symptoms such as hearing loss, pain or earache and dizziness will vary according to the underlying cause and the site of the problem.  The common problems are discussed below.

Otitis externa

This is an inflammatory condition of the outer ear, including the external auditory canal and although painful is readily treated with topical antibiotics and microsuction clearance.  Rarely , in immuno-compromised patients, infection can spread to the surrounding bone and this rare, but extremely serious condition, is called necrotising otitis externa and requires aggressive management.  Otitis externa is usually infectious, but can be caused by allergies, irritants or inflammatory conditions such as psoriasis and atopic eczema.  Infection can be localised as in a furuncle caused by Staphylococcus aureus or more generalised.  The causative organisms can be bacterial or fungal.  Fungal infection can be problematic, because it is prone to relapse as spores germinate.  Infection with herpes simplex and herpes zoster virus will give rise to Ramsey-Hunt syndrome with weakness in the facial nerve which passes through the ear.  Patients who wear hearing aids, or use cotton buds can traumatise the external canal and once established, because the ear canal is compromised by swelling and wax migration does not occur normally, the condition can be become chronic.

Symptoms include discharge and significant pain, and reduced hearing usually in this order, as opposed to acute otitis media (infection of the middle ear space with subsequent rupture of the drum and discharge of pus from the middle ear space), where pain settles with drum rupture and discharge.

Investigations

Diagnosis is usually made on otoscopic examination and swabs are only really required if there has been a failure of treatment.

Differential diagnosis

Ear discharge in children can be caused by the presence of:

  • foreign bodies, especially vegetative matter
  • impacted wax
  • otitis media with subsequent discharge
  • cholesteatoma - with tympanic membrane perforation and erosion of middle ear structures.  This will require formal surgical removal

Topical antibiotic drops, keeping the ear dry and avoiding instrumenting the ear are usually successful in settling symptoms rapidly, especially if combined with microsuction clearance.  Systemic antibiotics may be required if there is spreading cellulitis (infection of the outer ear).