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Feature Article

The discharging ear

Melville da Cruz

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Abstract

Most cases of discharging ear can be effectively treated with ear toileting and local antibiotic ear drops, although some will require specialist referral. Care is needed with the use of potentially ototoxic ear drops, particularly in otitis media with perforation or in the presence of grommets.

Key Points

  • A common problem in general and specialist practice, a discharging ear is usually caused by a bacterial or fungal infection of the external canal, or otitis media discharging through a perforation in the tympanic membrane.
  • Simple ear toilet techniques and local application of antibiotic drops and ointments in conjunction with waterproofing of the ear canal skin resolves most infections promptly.
  • Most available antibiotic ear drops are otoxic and can only be used in the discharging ear with perforation for a few days. If the discharge persists, referral to an ENT specialist is indicated.
  • Ear swabs are reserved for cases resistant to primary treatment or for at risk patients (those who have diabetes, are immune compromised or have had previous ear surgery or irradiation).
  • At risk patients and those cases with increasing pain, failure to respond to simple treatment or bleeding require referral for specialist assessment.
  • Cancer of the ear canal is rare but has similar symptoms to otitis externa that has responded poorly to treatment. A high degree of awareness is required.

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