How Should I Evaluate a Draining Ear?

Judith S. Lynch, MS, MA, APRN-BC


June 28, 2012

In This Article

Otitis Media and Otorrhea

Acute Otitis Media

Acute otitis media is not associated with otorrhea as a presenting sign. It is a complication of tympanic membrane perforation and may be associated with short-term hearing loss.

Usually, perforations will spontaneously heal within 2 months. A long-term perforation can be surgically treated by performing a tympanoplasty. Water protection is necessary for the affected ear.

Chronic Otitis Media

The chronic form of otitis media occurs when fluid persists behind the tympanic membrane. It is more common in children because the eustachian tube is shorter, narrower, and more horizontal than in adults. A unilateral chronic otitis media in adults may be a sign of a nasopharyngeal mass.

Symptoms include thick otorrhea; a retracted or perforated tympanic membrane; or, less commonly, a bulging tympanic membrane.

Treatment of chronic otitis media. The management of chronic otitis media includes:

  • Antibiotic therapy, if signs of acute infection are present;

  • If infection does not respond, tympanostomy tubes may be placed in the tympanic membranes by an ENT surgeon. Tympanostomy tubes require general anesthesia and should be reserved for patients whose infections are persistent or recurrent.[4] Usually, the tubes fall out spontaneously;

  • Adenoidectomy is considered if the adenoids are enlarged. Tonsillectomy has no effect on chronic otitis media.

Chronic Suppurative Otitis Media

Chronic suppurative otitis media is a draining ear with a history of recurrent acute otitis media, traumatic perforation of the tympanic membrane, or placement of tympanostomy tubes.[5] A common presenting symptom is hearing loss, without otalgia, in the affected ear. Fever and vertigo may be associated with chronic suppurative otitis media. Otorrhea is fetid, purulent, and cheese-like. Granuloma tissue may be present in the medial canal or middle ear space.

Antibiotic therapy may be started, and referral to an ENT specialist is suggested.


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