Evaluation of otorrhea (ear discharge) in children
- Christopher G Strother, MD
Christopher G Strother, MD
- Assistant Professor, Emergency Medicine and Pediatrics
- Mount Sinai School of Medicine
- Karin Sadow, MD
Karin Sadow, MD
- Medical Director
- PM Pediatrics of Mamaroneck
- Section Editor
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The evaluation of otorrhea in children is reviewed here. The approach to ear pain is discussed separately. (See "Evaluation of earache in children".)
Otorrhea means drainage of liquid from the ear. Otorrhea results from external ear canal pathology or middle ear disease with tympanic membrane perforation.
The table provides a list of etiologies for otorrhea in children (table 1). The history and physical examination will differentiate among most causes of otorrhea in children.
Life-threatening conditions — Otorrhea in the setting of a traumatized or immunocompromised patient may indicate a serious life-threatening condition.
Traumatic cerebrospinal fluid otorrhea — Cerebral spinal fluid (CSF) otorrhea is a serious sign in the setting of head trauma. If any ear discharge is noted after serious head trauma, particularly clear or bloody discharge, the patient should undergo evaluation for CSF otorrhea caused by a basilar temporal skull fracture. (See "Evaluation and management of middle ear trauma", section on 'Evaluation of ear or nose drainage' and "Skull fractures in children: Clinical manifestations, diagnosis, and management", section on 'Basilar skull fractures'.)
- Macfadyen CA, Acuin JM, Gamble C. Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations. Cochrane Database Syst Rev 2006; :CD005608.
- Sanna M, Russo A, DeDonto G. Color Atlas of Otoscopy, Thieme, New York 1999.
- Gliklich RE, Cunningham MJ, Eavey RD. The cause of aural polyps in children. Arch Otolaryngol Head Neck Surg 1993; 119:669.
- Harris KC, Conley SF, Kerschner JE. Foreign body granuloma of the external auditory canal. Pediatrics 2004; 113:e371.
- Persaud RA, Hajioff D, Thevasagayam MS, et al. Keratosis obturans and external ear canal cholesteatoma: how and why we should distinguish between these conditions. Clin Otolaryngol Allied Sci 2004; 29:577.
- Shire JR, Donegan JO. Cholesteatoma of the external auditory canal and keratosis obturans. Am J Otol 1986; 7:361.
- Rao AK, Merenda DM, Wetmore SJ. Diagnosis and management of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol 2005; 26:1171.
- Hannley MT, Denneny JC 3rd, Holzer SS. Use of ototopical antibiotics in treating 3 common ear diseases. Otolaryngol Head Neck Surg 2000; 122:934.
- DIFFERENTIAL DIAGNOSIS
- Life-threatening conditions
- - Traumatic cerebrospinal fluid otorrhea
- - Infectious complications of acute otitis media
- - Necrotizing otitis externa
- - Neoplasm
- Common conditions
- - Bacterial otitis externa
- - Foreign body
- - Acute otitis media
- - Chronic suppurative otitis media
- - Cerumen
- - Tympanostomy tube drainage
- Other conditions
- - Contact dermatitis
- - Bullous myringitis
- - Granulation tissue
- - Polyps
- - Otomycosis
- - First branchial cleft cyst
- - Cholesteatoma
- - Keratosis obturans
- - Spontaneous cerebral spinal fluid otorrhea
- Physical examination
- - External auditory canal cleaning
- - Physical findings
- Ancillary studies
- - Culture of ear drainage
- - Testing for cerebrospinal fluid otorrhea
- - Imaging
- - Tissue biopsy
- Life-threatening conditions
- Non-toxic children
- - Non-inflamed external canal
- - Inflamed external canal
- SPECIALIST REFERRAL OR CONSULTATION
- INFORMATION FOR PATIENTS