Otorrhea (Otorrhea)
1) Disease Description — Causes and Symptoms
- Definition: A symptom in which discharge flows externally from the external auditory canal or middle ear (ear discharge).
- Main causes
- Otitis externa (acute or chronic, external auditory canal eczema, fungal infection)
- Acute otitis media (when accompanied by tympanic membrane perforation)
- Chronic suppurative otitis media (may be accompanied by tympanic membrane perforation or cholesteatoma)
- Serous otitis media (mucous discharge caused by otitis media), trauma (such as tympanic membrane perforation)
- Rarely, tumors, after surgery, or an immunocompromised state
- Brief pathophysiology: Inflammation and infection in a lesion (of the external auditory canal, middle ear, or tympanic membrane) produce discharge, which is expelled externally. The nature of the discharge (serous/mucoid/purulent/bloody) varies according to the cause and location of the lesion.
- Main symptoms: Ear discharge (check the color, amount, and odor), ear pain or no symptoms, itching, hearing loss, foul odor or fever (in cases of infection), dizziness (when associated with the inner ear)
2) Treatment Methods
- Basic principle: After confirming the cause (external auditory canal vs. middle ear), administer treatment appropriate for the cause
- Diagnostic and treatment procedures
- Observation by an otolaryngologist using an otoscope or microscope (operating microscope)
- Bacterial culture of the discharge and blood tests when necessary
- Hearing test (when hearing loss is present) and imaging tests (CT) when chronic disease or complications are suspected
- Medication therapy
- Otitis externa: Topical antibiotic ear drops (a combination antibiotic and steroid solution) are effective in most cases
- Perforated discharge related to otitis media: Topical treatment when necessary, together with systemic antibiotics
- When tympanic membrane perforation is present or possible, use of aminoglycoside antibiotics (e.g., neomycin) as ear drops requires caution because of the risk of inner-ear toxicity — when possible, fluoroquinolone ear drops (e.g., ofloxacin) are recommended
- Fungal otitis externa (otomycosis): Topical antifungal medication
- Pain control: NSAIDs
- Procedures/Surgery
- Ear cleaning (ear toilet) and removal of discharge (in an outpatient clinic or procedure room)
- Persistent serous otitis media: Consider insertion of a tympanostomy tube
- Chronic suppurative otitis media or cholesteatoma: Surgical treatment (such as tympanoplasty or mastoidectomy)
- Lifestyle management
- Keep the ear dry (prevent water from entering); limit swimming
- Do not irritate the external auditory canal with foreign objects such as cotton swabs
- Take prescribed medications completely as directed
- Precautions
- Seek emergency medical care immediately if fever, severe pain, foul-smelling ear discharge, altered consciousness, dizziness, or facial paralysis occurs
- Do not stop ear drops arbitrarily or perform self-cleaning (e.g., vigorous water irrigation)
- Complications
- Hearing loss (temporary or permanent)
- Mastoiditis, cholesteatoma growth, facial nerve paralysis, and, rarely, intracranial complications (such as a brain abscess)
- Prognosis
- Varies depending on the cause and appropriateness of treatment. Otitis externa improves quickly with appropriate treatment. Chronic otitis media and cholesteatoma may require surgery and may recur.
3) Checklist Before an Outpatient Visit (Items to Bring and Information to Provide During the Visit)
- Items to bring
- List of medications currently being taken (prescription drugs, OTC medications, ear drops, etc.) and information about drug allergies
- Previous otolaryngology medical records, surgical history (especially ear surgery), and previous test results (hearing tests, CT, etc.)
- Symptom record: onset, discharge color (clear/yellow-green/젛/bloody), amount (small/large), presence or absence of odor, and changes over time
- Associated symptoms: ear pain, fever, decreased hearing, tinnitus, dizziness, facial paralysis, etc.
- Lifestyle history: swimming or diving history, work environment (exposure to dust or chemicals), and whether diabetes or immunosuppression is present
- Questions to prepare to explain to the doctor (examples)
- “When did the symptoms start, and how have they changed?”
- “What are the color, amount, and odor of the discharge?”
- “Have you recently injured or traumatized your ear (for example, with a cotton swab)?”
- “Have you recently gone swimming or participated in water-related activities?”
4) Examples of General Questions to Ask the Doctor
- What are the expected side effects of this medication (the prescribed ear drops or oral antibiotics)?
- How likely is surgery to be necessary given my current condition?
- Is the effect on my hearing reversible? When should I have additional testing (a hearing test)?
- What precautions should I follow in daily activities (showering, swimming, and exercise)?
5) Examples of Condition-Specific Questions (1–2)
- How should the possible causes be interpreted based on the color of this discharge (clear serous / mucoid / purulent / bloody)?
- Is my tympanic membrane perforated, and if so, which ear drops are safe to use?
(If necessary, please receive an accurate diagnosis of the cause and a treatment plan through examination and testing by an otolaryngology specialist.)