The ears, unfortunately, are a point of “attraction” for microbes and other pathological conditions, as they are particularly vulnerable, especially during childhood. One common indication of an underlying pathology is the discharge of fluid from the ear, also known as otorrhea. Otorrhea is not an independent condition but a symptom of an underlying issue that should always be examined. Although it may be harmless in many cases, fluid discharge should never be left unattended until (and if) it resolves on its own.
What is otorrhea?
Otorrhea is a symptom characterized by the discharge of fluid from one or both ears. More specifically, the fluid may be clear or contain pus, blood, or cerebrospinal fluid. The composition of the fluid can indicate various underlying causes, making medical evaluation essential.
Infections and otorrhea
Infections are the most common cause of otorrhea, especially in children. Both bacterial and viral pathogens can infect the ear, leading to inflammation and fluid discharge. Infections usually involve either the outer or middle ear, known as external or middle ear infection (otitis), respectively. External otitis refers to an infection in the outer ear canal, often called “swimmer’s ear” due to its association with prolonged moisture exposure, which disrupts the skin’s barrier, allowing bacterial growth. Symptoms include ear pain, itching, swelling, and otorrhea. Otorrhea in cases of external otitis often has a purulent, yellowish-green discharge and may have an unpleasant odor. Treatment involves topical antibiotics, often combined with corticosteroids to reduce inflammation. In severe cases or when the infection spreads beyond the ear canal, oral antibiotics may be necessary.
Middle ear infection (otitis media), on the other hand, refers to inflammation or infection of the middle ear and is another frequent cause of otorrhea, especially in children. It often occurs as a complication of viral upper respiratory infections, which then lead to a secondary infection behind the eardrum. Otitis media is classified as acute or chronic, depending on the duration and intensity of symptoms. In addition to otorrhea, symptoms include ear pain, fever, and hearing loss. In severe cases, the condition can cause a rupture of the eardrum, resulting in the discharge of purulent fluid into the outer ear canal. If the eardrum ruptures, surgical repair may be necessary, through a procedure called tympanoplasty.
Cholesteatoma and ear discharge
A cholesteatoma is an abnormal growth of squamous epithelium in the middle ear and mastoid cavity, often resulting from chronic otitis media. However, it may also be congenital, appearing at birth or during the early years of life, due to the presence of residual embryonic tissue in the middle ear (congenital cholesteatoma). This is an erosive epithelial lesion that causes recurrent, persistent foul-smelling or purulent discharge, hearing loss, and pain. In severe cases, it can lead to vertigo, facial nerve paralysis, and permanent hearing loss. Surgery is usually necessary to remove the cholesteatoma and restore the damaged middle ear structures. The surgical procedure of choice in this case is tympanomastoidectomy.
Ear injuries and otorrhea
Ear injuries can also lead to otorrhea, with the nature of the discharge depending on the severity and location of the injury. The most common injury that can occur is a tympanic membrane (eardrum) perforation. This may result from direct trauma, such as the insertion of foreign objects (e.g., cotton swabs), sudden pressure changes, or loud noises. The resulting otorrhea is often clear or bloody, and patients may experience pain, hearing loss, and tinnitus. Tympanic membrane perforations often heal on their own, but in some cases, tympanoplasty surgery may be required to repair the damage and restore hearing.
In addition, serious head trauma can cause fractures at the base of the skull. These fractures can lead to otorrhea due to cerebrospinal fluid leakage through the ear. Otorrhea in such cases is usually clear, watery fluid that may increase when the patient leans forward. This condition requires immediate medical attention, as it can lead to serious complications, such as meningitis.
Neoplastic causes of ear fluid discharge
Although less common, tumors affecting the ear or adjacent structures can also cause otorrhea. Both benign and malignant tumors can lead to fluid discharge.
As we can see, otorrhea is a symptom that can stem from numerous causes. In order to determine the exact cause, a personalized, detailed approach is essential. Early identification of the underlying cause and effective treatment are critical, particularly in cases where complications, such as hearing loss, meningitis, or facial nerve damage, can be particularly severe or even life-threatening. ENT Surgeon in Athens Dr. Olga Papadopoulou implements the appropriate diagnostic approach to identify the cause of ear fluid discharge and then proceeds with its restoration.