How Should I Evaluate a Draining Ear?

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

June 28, 2012

Cholesteatoma

Cholesteatoma is a destructive lesion of the skull base that can erode and destroy structures in the temporal bone. Classifications include congenital, primary acquired (a result of tympanic membrane retraction with ossicular destruction), and secondary acquired (as a direct consequence of injury to the tympanic membrane).

The hallmark of cholesteatoma is painless otorrhea, either unremitting or frequently recurrent. The condition is often resistant to antibiotic therapy. There is also a conductive hearing loss when large lesions fill the middle ear space. Tympanic membrane perforation is present in 90% of cases, and granulation tissue is common.

The management of cholesteatoma is otologic surgical excision of the lesion.^[5]

Key Points: When There is Drainage From the Ear

Drainage from the ear is commonly seen in primary care. The challenge to the clinician is to visualize all otic structures when the ear canal is occluded with otorrhea.

If there is any question of tympanic perforation, water should never be used to clean the EAC for better visibility. Rather, appropriate referrals should be made to retain the integrity of middle ear organs of hearing.

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