Pus Draining from Ear (Otorrhea)

Overview

Pus draining from the ear, medically known as purulent otorrhea, indicates an infection or inflammation in the ear. This discharge is typically thick, yellow, or greenish and may have a foul odor. It often signals a bacterial infection requiring prompt medical attention to prevent complications.

Common Causes

Middle Ear Infections

  • Acute otitis media with perforation: Middle ear infection causing eardrum rupture
  • Chronic suppurative otitis media: Long-standing infection with persistent drainage
  • Cholesteatoma: Abnormal skin growth in middle ear
  • Mastoiditis: Infection of mastoid bone behind ear

External Ear Infections

  • Otitis externa (swimmer's ear): Outer ear canal infection
  • Malignant otitis externa: Severe infection in diabetics/immunocompromised
  • Furuncle: Infected hair follicle in ear canal
  • Chronic otitis externa: Persistent outer ear infection

Other Causes

  • Foreign body: Object in ear causing infection
  • Trauma: Injury to ear canal or eardrum
  • Post-surgical: After ear surgery or tube placement
  • Skull fracture: Temporal bone fracture with CSF leak
  • Cancer: Rare ear canal or middle ear tumors

Associated Symptoms

  • Ear pain (may decrease after discharge begins)
  • Hearing loss or muffled hearing
  • Fever
  • Ear fullness or pressure
  • Itching in the ear
  • Ringing in the ear (tinnitus)
  • Dizziness or vertigo
  • Facial weakness (serious complication)
  • Headache
  • Swelling around the ear

Diagnosis

  • Otoscopic examination: Visual inspection of ear canal and eardrum
  • Culture and sensitivity: Identify bacteria and appropriate antibiotics
  • Hearing test: Assess hearing loss
  • CT scan: If complications suspected
  • Tympanometry: Test eardrum function

Treatment Options

  • Antibiotic ear drops: Topical treatment for infection
  • Oral antibiotics: For severe or systemic infection
  • Ear cleaning: Professional removal of discharge and debris
  • Pain management: Acetaminophen or ibuprofen
  • Keep ear dry: Avoid water exposure during treatment
  • Warm compresses: For pain relief
  • Surgery: For cholesteatoma or chronic infections
  • IV antibiotics: For severe complications

Home Care

  • Do NOT insert cotton swabs or other objects
  • Gently clean outer ear with warm washcloth
  • Use prescribed medications as directed
  • Protect ear from water during bathing
  • Avoid swimming until cleared by doctor
  • Complete full course of antibiotics

When to Seek Emergency Care

Seek immediate medical attention for:

  • High fever (over 103°F/39.4°C)
  • Severe headache or neck stiffness
  • Facial drooping or weakness
  • Confusion or altered mental state
  • Swelling or redness behind the ear
  • Clear fluid drainage after head injury
  • Severe dizziness or vertigo
  • Vision changes

Prevention

  • Treat ear infections promptly
  • Keep ears dry after swimming
  • Avoid inserting objects in ears
  • Manage allergies and upper respiratory infections
  • Use earplugs when swimming in contaminated water
  • Control diabetes if present