Discharging Ear

TRIAGE QUESTIONS

Question 1: What side is it?

  • Record the laterality and please avoid abbreviations such as 'rt' or 'R'

 

Question 2: Is it painful? 

  • If painful, likely to be acute infection

  • If painless, likely to be chronic condition

 

Question 3: Adult or child? 

  • Painful ear discharge in an adult is likely to be acute otitis externa

  • Painful ear discharge in a child is likely to be acute otitis media discharging through a perforation

  • If painless in an adult or child, it may be some form of chronic otitis media ie infection or chronic discharge through a perforated tympanic membrane

 

Question 4: Is the discharge greenish, custard-like and smelly?

  • If yes, then this goes with an acute infection ie otitis externa or media

  • If it's watery/clear and not very smelly, then this may be a form of chronic otitis media with discharge coming through a perforated tympanic membrane

  • If it's thick and white like rice pudding, then it could be fungal otitis externa

 

PLAN

  • The treatment for discharging ear = topical drops

  • Most drops are similar in efficacy so select one with reference to the status of the tympanic membrane and allergy history

  • Antibiotic/steroid +/- acetic acid preparations such as Otomize and Sofradex are effective

  • For adults, the usual dose is three drops tds for 7-14 days; reduce dose for younger children

  • For non-specialist care, avoid gentamicin in the presence of a perforation; in many places, ciprofloxacin drops are reserved for specialist use too

  • Give Canesten or Locorten drops for fungal otitis externa

  • See otitis externa, acute otitis media or chronic otitis media for further information.

 

TRIAGE FLOWCHART

To download the PDF version of this flowchart, please click on the image.

 

 

 

Page last reviewed: 1 December 2022