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Otorrhea

Introduction

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Synonyms and keywords: Drainage from the ear; ear bleeding; bleeding from ear; ear discharge

Overview

Overview

Ear discharge may be caused by an irritation or inflamed tissue within the mastoid, ear canal, or middle ear.

Pathophysiology

When the middle ear becomes acutely infected by bacteria, pressure builds up behind the ear drum, usually but not always causing pain. In severe or untreated cases, the tympanic membrane may rupture, allowing the pus in the middle ear space to drain into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a traumatic process, it is almost always associated with the dramatic relief of pressure and pain.

Natural History, Complications and Prognosis

Instead of the infection and eardrum perforation resolving, drainage from the middle ear can become a chronic condition. As long as there is active middle ear infection, the eardrum will not heal.

Diagnosis

CT

CT of temporal bones may be performed for cholesteatoma, mastoiditis, and CSF otorrhea.

Treament

Medical Therapy

Foreign bodies can be removed with alligator forceps under magnification. In a simple case of acute otitis media in an otherwise healthy person, the body’s defenses are likely to resolve the infection and the ear drum nearly always heals. Antibiotic administration can prevent perforation of the eardrum and hasten recovery of the ear.

References

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Historical Perspective

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References

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Classification

Overview

Classification

References

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief:

Pathophysiology

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Overview

When the middle ear becomes acutely infected by bacteria, pressure builds up behind the ear drum, usually but not always causing pain. In severe or untreated cases, the tympanic membrane may rupture, allowing the pus in the middle ear space to drain into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a traumatic process, it is almost always associated with the dramatic relief of pressure and pain.

References

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

Overview

Common causes of otorrhea include infectious, malignant, and trauma-related aural conditions.

Causes

Common Causes[1][2]

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning Contaminated water
Dental No underlying causes
Dermatologic Dermatitis of the external canal, Epidural abscess, Infectious eczematoid dermatitis
Drug Side Effect No underlying causes
Ear Nose Throat Aural polyps, Cerebrospinal fluid otorrhea, Cholesteatoma, Chronic otitis media, Infectious myringitis, Malignant otitis externa, Mastoiditis, Myringitis, Occult cholesteatoma, Otitis externa, Otitis media with perforated tympanic membrane
Endocrine Adenoidal hypertrophy
Environmental Foreign body
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic [[Prolonged topical antimicrobial use]
Infectious Disease Actinomyces, Aspergillus, Candida albicans, Chronic otitis media, Epidural abscess, Haemophilus influenzae, Infectious eczematoid dermatitis, Infectious myringitis, Mastoiditis, Moraxella catarrhalis, Prolonged topical antimicrobial use, Pseudomonas aeruginosa, Streptococcus pneumoniae, Tuberculosis
Musculoskeletal/Orthopedic Basilar skull fracture, Cerebrospinal fluid otorrhea
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Aural polyps, Cholesteatoma, Malignant tumor, Occult cholesteatoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Tuberculosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Granulation tissue, Immunodeficiency
Sexual No underlying causes
Trauma Basilar skull fracture, Otitis media with perforated tympanic membrane, Skull fracture, Trauma, Tympanic membrane rupture
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S. Kiran Singh, M.D. [2]

Differentiating Otorrhea from other Diseases

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References

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Epidemiology and Demographics

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Risk Factors

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References

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Natural History, Complications and Prognosis

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Overview

Instead of the infection and eardrum perforation resolving, drainage from the middle ear can become a chronic condition. As long as there is active middle ear infection, the eardrum will not heal.

References

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

Related Chapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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