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Otorrhea: Causes and treatment of fluid or discharge from the ear

Last update on Mar, 14, 2024

Otorrhea, or ear drainage, is a common condition that can affect people of any age. It can also be a sign of several health conditions, depending on the type of fluid coming out of the ear. Read on to learn more about this condition, its various types and how to treat ear drainage. 

What is otorrhea or ear discharge?

Otorrhea is the medical term for ear drainage and is occasionally referred to as “watery ears” or “runny ears.” In most cases, this ear drainage is the result of a ruptured eardrum from an ear infection. This hole in the eardrum allows fluid from your middle ear to drain out into your ear canal. 

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What causes otorrhea?

In most cases, ear drainage is the result of a perforated tympanic membrane, or a ruptured eardrum, from an ear infection. Building pressure from fluid accumulation in the middle ear causes the eardrum to rupture, allowing the fluid to drain out into the ear canal. Other otorrhea causes include:

  • swimmer’s ear (otitis externa),
  • foreign objects in the ear,
  • severe trauma to the head or ears.

Otorrhea occurs most often in children, whose smaller and narrower Eustachian tubes put them at a higher risk of developing ear infections. If a child has chronic ear infections, doctors may place ear tubes into the eardrum to allow air to flow into and drainage out from the middle ear, preventing fluid buildup behind the eardrums.  In rarer cases, otorrhea can be caused by: 

  • cholesteatoma (an abnormal skin growth behind the eardrum),
  • psoriasis,
  • fungal infection,
  • malignant otitis externa (a complication of swimmer’s ear).

These are unlikely causes of otorrhea; discuss your symptoms with a doctor to determine what might be causing your ear drainage.

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Does ear drainage or discharge mean an infection?

While otorrhea is often the result of an ear infection, ear drainage itself doesn’t necessarily mean that you have an infection. Otorrhea can occur if a foreign object is stuck in the ear, after a head injury or following improper ear cleaning, or after being in water. However, otorrhea is most commonly a symptom of a middle ear infection (otitis media).

What does ear drainage or discharge look like?

Otorrhea will appear in various colors and forms, depending on the type and cause of the drainage. You may notice it leaking from the ear, or you may notice it dried in the ear canal or on your pillow. Monitor your symptoms by taking note of the color and volume of the drainage, as well the number of days you notice drainage. 

What are the types of otorrhea?

Otorrhea appears in several different forms, depending on the root cause and severity of the problem. Recognizing the signs of the various types of ear drainage can help you determine how to treat otorrhea. The primary types of otorrhea include:

  • Purulent: This type of discharge contains pus or a cloudy fluid. It’s the most common type of ear drainage and caused by an ear infection.
  • Serous: This drainage contains serum, a protein-rich liquid found in the blood. It’s most often caused by an ear infection and is thin and watery.
  • Sanguineous or bloody: This ear discharge contains blood. This can be drainage from a minor scratch in the ear, a foreign object in the ear or following an injury.
  • Mucoid: This type of otorrhea contains mucus. In most cases, mucoid discharge is caused by blocked Eustachian tubes, resulting in a buildup of mucus in the middle ear.
  • Clear: Clear or watery discharge, or ear drainage without any visible coloring, can be caused by skin irritation such as eczema.
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What are the symptoms of otorrhea?

The most noticeable otorrhea symptoms are simply drainage from the ear. This drainage may appear in several different ways: it may be odorless or have a distinct, foul smell; it may be thick or thin in consistency; and it may be clear, yellow, greenish or bloodied in color. The exact appearance of the ear discharge will vary depending on what is causing the ear to drain. Other otorrhea symptoms include:

More serious symptoms include:

Those experiencing these more serious symptoms may have also experienced recent head trauma.  

How can otorrhea be diagnosed?

To receive an otorrhea diagnosis, your healthcare provider will perform a variety of physical exams to determine the cause behind your ear drainage. These may include:

  • Vitals check for a fever
  • Ear canal inspection for drainage, signs of infection or a ruptured eardrum
  • Physical check on ears, jaw and neck for swelling or abnormalities
  • Skin examination for redness and inflammation

You might also hear your doctor talk about an otorrhea differential diagnosis. It simply means that you have symptoms that match more than one cause or condition, so further testing needs to be done. Some of those additional tests could include:

  • Audiograms: This test will measure your hearing range.
  • CT scan: This imaging test will determine if the infection has spread beyond your middle ear.
  • Cranial nerve examination: This will test your cranial nerves to ensure they’re functioning properly. This test will only be administered if you’ve experienced recent head trauma or you’re having trouble seeing, swallowing or speaking.
  • MRI: This magnetic imaging test is used to detect any cerebrospinal fluid leaks. It’s used primarily for those who have experienced recent head injuries.
  • Culture: Your doctor may sample your ear drainage to test for any bacteria or fungi growth.

Discuss your symptoms honestly and thoroughly with your doctor during your visits to help them make an accurate diagnosis. Otorrhea can be a sign of numerous conditions, so clear communication about your symptoms can help direct further testing.

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How do you treat otorrhea or stop ear drainage?

Similarly to receiving a diagnosis, otorrhea treatment focuses on treating the cause of the drainage.

  • Ruptured eardrum: If the otorrhea comes from a ruptured eardrum, it will often resolve on its own. If the eardrum doesn’t heal on its own or appropriately, a tympanoplasty to repair the eardrum may be required.
  • Bacterial ear infection: If otorrhea is the result of a bacterial ear infection in the middle ear, your infection may be able to heal itself. If symptoms don’t improve, your doctor may prescribe antibiotics.
  • Swimmer’s ear: Your doctor may prescribe antibiotic ear drops if you’re experiencing otorrhea as a result of swimmer’s ear.

If the exact cause can’t be singled out, you may be referred to a hearing care specialist, otolaryngologist or a neurosurgeon (if head trauma is involved) for additional evaluation and treatment.

How do you prevent otorrhea?

Otorrhea isn’t 100% avoidable, but these small otorrhea prevention steps can help reduce your risk of ear drainage. If your ear drainage is caused by otitis media:

  • Wash hands and cover coughs to prevent the spread germs
  • Don’t smoke, and avoid exposure to secondhand smoke
  • Stay up to date on vaccinations, particularly for the flu
  • Avoid sudden or extreme temperature shifts

If your otorrhea is the result of swimmer’s ear:

  • Dry your ears fully after a shower or a bath
  • Wear specialized ear protection when swimming to prevent water from entering the ears
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When to see a doctor

While otorrhea generally goes away in a few days as an ear infection resolves, schedule an appointment with your physician if your ear drainage lasts more than three days. Meet with your physician as soon as possible if you notice any additional symptoms, including pain, fever or redness around the ears and neck. Your doctor will review your symptoms and provide further treatment recommendations to address the ear drainage.

If you’ve noticed otorrhea following recent head trauma or injury, call 911 or go to an emergency room. Seek immediate care if you’re unable to speak, swallow or see. Otorrhea is a symptom of multiple health conditions, both serious and benign, so immediate conversations with your doctor are important.

When to see a hearing specialist

First consult with your physician and then they will refer you to the hearing care specialist when appropriate. When ear infections are left untreated, they may cause hearing loss.

FAQs about otorrhea and ear discharge

Otorrhea can be short-term (acute) or long-term (chronic). It depends entirely on the cause of the ear drainage. If your symptoms are caused by a bacterial infection in the middle ear, your ear infection—and ear drainage—will resolve itself in a few days. For most ear infections and related otorrhea, your doctor might advise that it’s best to allow the infection to heal on its own.

In the case of otorrhea caused by a ruptured eardrum from an ear infection, it may take several weeks for the eardrum to heal on its own. If antibiotics are needed for a prolonged ear infection, your doctor may prescribe a course of medication. 

All fluid drainage from the ears occurs with the help of the Eustachian tubes, a small pathway that runs from both of the middle ears to the back of the nose and throat. The tubes, which also equalize pressure in the middle ear and protect it from bacteria, drain excess fluids and secretions from the middle ear into the throat. Ear infections and ear drainage into the ear canal occur when the Eustachian tubes are blocked and unable to properly drain fluid from the middle ear.

Otorrhea complications are uncommon—once its root cause is addressed, drainage should come to an end. However, a very rare complication of ear infections is the development of chronic suppurative otitis media, or ongoing chronic infection of the middle ear without an intact tympanic membrane. This condition, which is a chronic inflammation of the space behind the eardrum, is characterized by chronic otorrhea with a ruptured eardrum. 

The ear drainage itself isn’t contagious and can’t infect others. The same is true for an ear infection—the infection itself can’t be shared. However, if your ear infection and related otorrhea are caused by a cold or the flu, it can spread to others through coughing, sneezing or poor hygiene. 

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