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Otorrhea is a term commonly used within the field of audiology and medicine. It refers to any drainage from the ear canal. Typically, the drainage is associated with an outer ear or middle ear infection, also known as Otitis Externa or Otitis Media. Otorrhea comes in many forms: it can be clear or colored, odorless or foul smelling, thick or thin, and it may sometimes include blood. Your ears should not drain without cause. Any prolonged drainage or if you are experiencing any new drainage from your ear canal, it is important to seek medical attention from your Primary Care Provider, Pediatrician, or an Ear Nose and Throat (ENT) physician if this is an on-going concern. Your physician can help determine the cause of the drainage as well as create a treatment plan for treating it. They will often also send you to an audiologist to determine if this drainage is affecting your hearing.

Types of Otorrhea

There are five main types of otorrhea: clear, bloody, serous, mucoid, and purulent. Serous otorrhea is thin and watery, mucoid otorrhea resembles mucus, a snot-like substance, and the final type is purulent. Purulent otorrhea is the most common type of otorrhea which typically includes pus and is actively draining from the ear canal.

What causes otorrhea?

Otorrhea can be very common in children due to their active levels and their anatomy. Children are commonly very active outside, and often playing with water. This water can build-up within their ear canals, cause infections, and then drain out of the ear canal. The Eustachian tube, which is a canal that connects the middle ear and nasal cavity to the back of the throat, also starts off horizontal at a young age. Therefore, if any fluid accumulates within the air-filled middle ear cavity, it does not drain very well. As we grow older, our Eustachian tube starts to slant downwards, allowing fluid to drain more naturally.  Otorrhea can be acute or chronic. Acute otorrhea is drainage lasting six weeks or less, while chronic otorrhea is drainage lasting longer than six weeks.

Causes of otorrhea

There are many causes of otorrhea, and in some cases having drainage from your ear is quite normal. If you have a history of Otitis Media, the most common form of treatment is to have Pressure Equalizing Tubes (PE tubes) inserted into your eardrum by an ENT. This includes a surgery where the ENT cuts a small slit into your eardrum and inserts a small rubber tube that acts as an opening from the middle ear into your ear canal. This opening allows any infection or fluid within the middle ear to drain into the ear canal. This type of fluid drainage is completely normal, as that is the result of a successful surgery. These tubes will stay placed within the eardrum for anywhere from a few months to a year, and then they naturally fall out on their own. Abnormal drainage causes include Otitis Externa, an accidental perforation of the eardrum, a head injury, or injuries to your ear canal by foreign bodies or q-tips.

In cases where the drainage is new and not on purpose, like with PE tubes, it is important to seek medical care from an ENT. When you see an ENT make sure to report any recent accidents or changes in health/medications. The ENT will perform otoscopy, which is when they use their ear light to look into your ear canal. They may also perform another test called tympanometry, which is introducing pressure into your ear canal to determine the functionality of your eardrum and middle ear bones. The ENT will then classify the type of otorrhea and create a treatment plan with you. Some questions you can ask are how long you need to continue the treatment plan, what does the follow up schedule look like, what should I do if the drainage changes, and will this be recurring? Treatment of otorrhea varies depending on the severity and type. Antibiotics may be prescribed to get rid of any infection. The ENT may use suction to remove any standing drainage within the ear canal or around the eardrum. PE tubes are often a last resort and used in the treatment of chronic drainage and ear infections. Guidelines for PE tubes include chronic otitis media, lasting at least three consecutive months, in children ages 6 months to 12 years old. Above this age, more permanent style PE tubes can be inserted called t-tubes. Unlike PE tubes which are generally in your ear drum for up to 12 months, T-tubes can be in your ear drum for up to 5 years. If you have acute otitis media, your ENT will either recommend the watch and wait method or oral antibiotics. Prevention should also be discussed including creating custom swim earplugs to reduce the amount of water within the ear canal. After creating a treatment plan, it is also important to have your hearing tested before the start of the treatment and after, to get a baseline of hearing and see if the treatment/drainage affected hearing.

On rare occasions otorrhea is associated with severe conditions like mastoiditis, an infection within your mastoid bone, or a cholesteatoma, an outer or middle ear cyst growth. Usually, these conditions come with other severe symptoms that alert you to the fact that something is wrong with your ear. It is important to seek immediate medical intervention in these cases, as surgery can often resolve the infection/growth. For mastoiditis or a cholesteatoma, permanent hearing loss is often a result, and you would need to seek care from an audiologist for treatment.

Otorrhea can also be present with other ear conditions, like aural fullness or otalgia. Aural fullness could be caused by a number of things but occurs within our outer or middle ear. One of the most common causes of aural fullness is occluding cerumen. When our ear canals become completely occluded by cerumen, our ears become full and itchy. It may be tempting to use Q-tips to clean your ears out at home, but the best method is to visit your audiologist. They can remove the cerumen using a manual tool, water irrigation, or suction. Water irrigation is the fastest and easiest method, as the water flushes all of the cerumen out of the ear canal in seconds. Suction is another method which applies a tiny tool to suction the contents of your ear canal into a basin. If you do not have cerumen in your ear canal but still report fullness it could be otitis media. Otitis media occurs when the middle ear space, which is typically an air-filled cavity, becomes filled with thick fluid and bacteria. This infection then causes that “plugged feeling” as if you are swimming underwater. If your ear canals are clean and you have no current ear infection, the fullness could represent a significant decrease in your hearing ability. This is our ears’ way of warning us that our hearing has changed, and we need to see a doctor. Otalgia refers to pain within the ear canal and can be caused by an open sore, a foreign object within the ear canal, physical injury to the pinna, or tension within your jaw, which are similar to otorrhea causes. Open sores within the ear canal can be painful, especially if you wear hearing aids or earbuds that consistently rub up against the sore. If you have a cut within your ear canal, we recommend that you stop wearing in-the-ear devices for 1-2 weeks, or until your sole has healed and the pain subsides. Foreign objects within the ear canal can cause significant pain because your ear recognizes that it does not belong there. This is more common for young children as they often stick beads, food, or rocks within their ears. If the object is pushed too far, it can puncture the eardrum and cause hearing loss. In the event that you or your child have something stuck within your ear canal, visit an ENT to have it professionally removed. Please do not try to remove it yourself at home as this can be extremely dangerous. Tension within your jaw can also be misinterpreted as ear pain due to the close proximity of our ear and jawbone. The temporomandibular joint, our jaw socket, is located directly below the ear canal along with our back molar teeth. TMJ, grinding your teeth, or a tooth infection can all cause pain within our jaw that radiates to our ear canal. When you see an audiologist, they will often ask about these conditions because then they can refer you to a dentist for the correct type of intervention. By resolving the tooth/jaw issue, the ear pain is also resolved. It is also not uncommon to have an associated fever with either otalgia or otorrhea.

Our ears have many jobs! This article mostly focuses on their responsibility of keeping unwanted objects away from our eardrums and as a way for our body to remove infected fluid from our middle and or outer ear space. If you or your child have had an accident such as a trauma via foreign object into your middle ear space please contact your provider or ask for a referral to an audiologist or ENT. If you or your child are experiencing any drainage it is better to investigate its source and document the type of drainage rather than waiting. Often otorrhea is easily managed with early intervention!

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