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.
