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
- 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.
For a visual representation, please see the Discharging Ear flowchart.
Page last reviewed: 23 September 2016