Most patients with an aural discharge can be effectively treated with ear toileting and antibiotic ear drops, although some require specialist referral. Care is needed with the use of potentially ototoxic ear drops, particularly in patients with otitis media with perforation of the eardrum or grommets.
- An ear discharge is usually caused by a bacterial or fungal infection of the external ear canal or otitis media discharging through a perforation in the tympanic membrane.
- Simple ear toileting techniques and local application of antibiotic drops and ointments in conjunction with waterproofing of the skin of the ear canal resolve most infections promptly.
- Most available antibiotic ear drops are ototoxic and can only be used in a discharging ear with perforation for a few days.
- Ear swab cultures may be useful if treatment fails, and in patients who have diabetes or are immunocompromised.
- Patients with increasing pain or bleeding and those who fail to respond to simple treatment or who are at risk due to diabetes, immunocompromise or previous radiotherapy 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, and a high degree of awareness is required.