Consult
Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus
(purulent). Depending on the cause of the discharge, people may also have ear pain, fever, itching, vertigo, ringing in
the ear (tinnitus), and/or hearing loss. Symptoms range from sudden and severe to slowly developing and mild.
Causes
Discharge may originate from the ear canal, the middle ear, or, rarely, from inside the skull.
Overall, the most common causes of ear discharge are
Acute (sudden and severe) middle ear infection (otitis media) with perforation (puncture) of the eardrum
Chronic otitis media(with perforation of the eardrum, cholesteatoma, or both)
External ear infection (otitis externa)
In some people with otitis media (usually children), the eardrum ruptures, releasing the infected material collected
behind the eardrum. The hole in the eardrum almost always heals, but sometimes a small perforation remains. A
perforation may also result from injury or surgery to the eardrum. When a perforation is present, people are at risk of
chronic middle ear infections, which can cause ear discharge.
Serious, but rare, causes of ear discharge include
Cancer of the ear canal
Fracture of the base of the skull
Necrotizing external otitis
Cholesteatoma (a noncancerous growth of white skinlike material in the middle ear)
The ear canal passes through the base of the skull. If a skull fracture (from a severe head injury) involves that part of
the skull, blood and/or cerebrospinal fluid may leak from the ear.
Necrotizing, or malignant, external otitis is a particularly severe form of external ear infection that typically occurs only
in people with diabetes or those who have a compromised immune system (due to HIV infection or chemotherapy for
cancer).
Some people with chronic otitis media develop a noncancerous (benign) growth of skin cells in the middle ear
(cholesteatoma) that can cause discharge. Although a cholesteatoma is noncancerous, it can cause significant damage
to the ear and nearby structures. In severe cases, a cholesteatoma may lead to deafness, facial weakness or paralysis,
and complications with the brain such as an abscess and other infections.
Evaluation
The following information can help people decide when a doctor's evaluation is needed and help them know what to
expect during the evaluation.
Warning signs
In people with ear discharge, certain symptoms and characteristics are cause for concern:
Recent major head injury
Any neurologic symptoms (such as vertigo or difficulty seeing, speaking, swallowing, and/or talking)
Hearing loss in the affected ear
Fever
Redness and/or swelling of the ear or area around the ear
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