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Discharging Ear: Types, History and Examination
Few problems are as frustrating to the otolaryngologist as the persistently draining ear
The management of the problem hinges upon the ability of the physician to determine the site of origin and the underlying cause of this drainage.
Types of Ear Discharge
- Waxy: Wax , Keratosis obturans.
- Haemorhagic: Trauma, acute otitis media, chronic otitis media, herpes zoster, bullous myringitis, tumor.
- Mucoid: ASOM, CSOM.
- Purulent: External otitis, foreign body, Myringitis, ASOM, CSOM, tumors.
- Sero-sanguinous: External otitis, foreign body, HVZ, CSOM. Watery: CSF, atopic dermatiti
History of Ear Discharge
- Onset
- Duration:
- Acute:
- Chronic: Chronic otitis externa, Mastoid cavity, tympanostomy tubes
- Progression
- Past treatments
- Associated phenomenon:
- Deafness
- Tinnitus
- Vertigo
- Feeding habits
- Snoring
Examination
- Aural toilet by either cotton applicator or suction. Do not use syringing to clean a discharging ear.
- Determine site by systematically examining the pinna, external auditory meatus, tympanic membrane and the middle ear.
- Assess hearing by voice tests, tuning fork tests and after aural toilet by PTA.
- In cases of CSOM or recurrent ASOM, assess eustachian tube function after controlling the acute episode.
- Examine the rest of the ENT, paying special attention to tonsils and adenoids, and nasal obstructive lesions.
Investigations
- CBC
- C/S
- X-rays of the ear, nasopharynx and sinuses.
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