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 externaacute 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