The ear extends beyond the visible part that we see on the side of the ear. It continues deeper into the skull and any problem of any parts of the ear can present with a host of symptoms like ear discharge. Understandably the sigh of any discharge from the ear can be considering especially when it is not the typical brown and thick earwax that we are accustomed to, and ear secretions can sometimes be a sign of a serious underlying disorder. However, it can also occur with minor acute conditions that will pass on its own in due course.
The ear is broadly divided into three parts – the outer ear, the middle ear and the inner ear. The outer ear directs sound waves towards the middle ear which then transmits it to the inner ear. The hearing apparatus lies within the inner ear as does the organ of balance. Although these are three distinct portions with different structures, a disease in one area can cause symptoms in another part.
Types of Secretions
The eardrum separates the middle ear from the outer ear, which is composed of the ear canal and pinna. Any secretions that we see or feel are usually from the outer ear provided that the eardrum is intact. These secretions can be broadly described as serous, blood or pus (purulent discharge). Even blood or pus may be mixed with serous fluid although it is not overtly visible.
- Serous fluid is a thin and clear discharge that may at times be sticky.
- Blood is the fluid that escapes from a ruptured blood vessel.
- Pus is a yellow to green thick fluid containing dead cells and bacteria.
The type of discharge does play some role in indicating the location, nature of the condition and even severity of the underlying cause. The color and odor also can prove helpful in this regard. A red discharge is usually indicative of bleeding, while a green to yellow discharge indicates pus due to an infection or chronic inflammation. A foul smelling discharge is also an indication of infection. Similarly accompanying symptoms may also provide a clue to the possible cause. There may be pain, swelling of the ear, itching, hearing loss, tinnitus (ringing in the ears), vertigo and poor coordination depending on the underlying cause.
Causes of Ear Discharge
The most common causes of an ear discharge are outer ear infection, middle ear infection and severe head injury. However these are not the only causes and if excluded, other conditions need to be considered. Some of these conditions can be very serious and life-threatening even if there are no other symptoms beyond the ear discharge.
Otitis externa or outer ear infection is a common problem in both adults and children. It occurs with inflammation of the ear canal usually due to an infection. However, sometimes otitis externa may be due to irritation or trauma of the ear canal without an infection. This condition is frequently seen in swimmers and is therefore commonly referred to as swimmer’s ear. Nevertheless it can occur even without any infection of the ear canal and associated outer ear structures.
Otitis externa can be acute or chronic. Acute otitis externa is usually due to bacterial infections but as mentioned it can occur with trauma to the ear like with the insertion of a foreign body and injury when picking the ear with an object. Chronic otitis externia is often associated with fungal infections that can persist for weeks or months until treated. Itching, pain and a clear to purulent discharge are some of the symptoms seen with the different cause of otitis externa. Less commonly, allergies may be involved.
Otitis media or middle ear inflammation is another common problem and often seen in children. Most of the time it arises with a viral or bacterial infection of the middle ear related to respiratory tract infections. When the nose of throat is infected, these microbes can then travel up into the middle ear through the eustachian tube which connects to the back of the nose. Allergies are another possible factor in the development of otitis media mainly because it increases the likelihood of infections.
Even when a middle ear infection is successfully treated, fluid may build up here and can provide an environment for bacteria to regrow. This accumulation of fluid is referred to as an effusion. The secretion will not be see unless the ear drum ruptures. Sometimes ventilation tubes (grommets) need to be inserted into the eardrum to allow this effusion to drain out. Apart from pain deeper in the head and fever, a person with otitis externa may also experience some degree of hearing loss and vertigo which is often temporary.
The bones of the skull that separate the brain within the cranium from other head structures is thin and easily fractured. Any severe trauma can therefore lead to bleeding which may exit via the ear (otorrhea). Major falls, car accident injuries and blows to the head can lead to otorrhea. The fluid that is then expelled may either be cerebrospinal fluid (CSF) that surrounds the brain or blood. Sometimes it may be a combination of both fluids that is expelled through the ear where the CSF is stained with blood.
Bleeding from the ears (otorrhea) may be accompanied by bleeding from the nose (rhinorrhea). This is beyond just a nosebleed. Otorrhea and/or rhinorrhea are considered to be very serious symptoms of traumatic head injury. It needs immediate medical care and diagnostic investigations such as a CT scan. Other symptoms like headaches, visual disturbances, confusion and loss of consciousness may also occur. Surgery may be necessary at times, particularly to stop bleeding within the cranial cavity.
- Cholesteatoma where a keratin (skin protein) plug forms in the middle ear).
- Foreign body in the ear, mainly seen in children.
- Malignancy such as cancer in the ear canal or middle ear.
- Acne vulgaris (pimples) in the entrance of the ear canal.
- Skin diseases like atopic dermatitis which extends into the ear canal.
- Mastoiditis which is an infection of the mastoid process (bone) of the skull.