Discharge from the ears (otorrhoea) is common, and it is caused by diseases of the external auditory canal, such as otitis externa, or diseases of middle ear , including otitis media.An offensive smelling discharge is more common with chronic infections, particularly due to gram negative bacteria.
History of the patient with otorrhea should include the following:
- Duration of symptoms
- Presence of fever
- History of trauma to upper body especially above the shoulders
- History of swimming
- Does the patient clean his/her ears with cotton-tipped swabs
- Pruritus in ear
- Upper respiratory symptoms compatible with viral infection
- History of recent air travel
- History of recent diving
- Hearing loss.
- If the patient looks toxic document the presence or absence of mental status changes as well as other systemic signs.
The physical exam should include:
- Inspection of the external ear and canal
- Palpation of the mastoid bone
- Palpation of the neck
- Inspection of the tympanic membrane
- Insufflation of air in the canal to document adequate movement of the tympanic membrane.
- A neurological exam is appropriate in toxic patients and in those patients complaining of headache or with a history of trauma.
