Otorrhoea

Question 1

What is otorrhoea?

Answer 1

Ear discharge i.e. wax, pus, blood, mucus, CSF

Question 2

What causes otorrhoea?

Answer 2

Most common bacterial pathogens in discharging ear:

=> pseudomonas aeruginosa

=> staph. aureus

=> Proteus spp.

=> Strep. pneumonia

=> Haemophillus influenza

=> Moraxella catarrhalis

Question 3

Diagnosis is made based on a good hx and examination.

This involves:

=> Duration of discharge i.e. if chronic think chronic otitis media inc. cholesteatoma especially if unilateral

=> Is there assoc. otalgia?

=> Assoc. fever or systemic symptoms indicates infective aetiology

=> Assoc. hearing loss / dizziness?

=> History of putting foreign bodies in ears esp. in children

=> Facial nerve palsy - may occur with acute or chronic otitis media

=> Check for hx of trauma - CSF otorrhoea

=> Recent hx of topical antibiotics? This can cause discharge / predispose to fungal ear infections with prolonged use

Answer 3

INFO CARD

Question 4

Differential diagnosis for otorrhoea:

1. Fungal otitis externa

=> itchy ear canal

=> fluffy whitish/yellow/green/black coating of the canal

2. Acute otitis media ± perforation

=> recent upper respiratory tract infection

=> deep severe ear pain which precedes discharge and improves after discharge appears

=> mucoid ear discharge

3. Otitis externa

=> itchy ear canal

=> scanty, thin, watery discharge

=> external ear canal may be completely occluded with discharge and swelling

Answer 4

4. Necrotising otitis externa (malignant otitis externa)

=> unilateral severe ear pain

=> foul smelling discharge

=> cranial nerve palsies

5. Cholesteatoma

=> unilateral chronic offensive smelling ear discharge

=> hearing loss

=> ear drum retraction / perforation with keratin accumulation

6. CSF otorrhoea

=> hx of trauma or skull base surgery

=> clear, watery discharge