EAR DISCHARGE

Ask the following questions:

1. Is it acute? Acute ear discharge suggests acute otitis media with rupture or an otitis externa, especially if it is painful. A chronic discharge would suggest cholesteatoma, chronic otitis media, and possibly cerebrospinal fluid.
2. Is it painful? A painful ear with a discharge is most likely acute otitis media with rupture. It may, however, be due to otitis externa, a foreign body, or serous otitis media.
3. Is there associated fever? An ear discharge with fever suggests otitis media, mastoiditis, and petrositis.
4. What is the character of the discharge? A mucopurulent discharge suggests chronic otitis media and mastoiditis, whereas a fetid discharge with whitish debris suggests a cholesteatoma. If the discharge is clear, a cerebrospinal fluid otorrhea should be suspected.

DIAGNOSTIC WORKUP

The most important test to do is a smear, culture, and sensitivity of the discharge. If there is fever, a CBC, sedimentation rate, and chemistry panel should be done. The ears should be examined after thorough irrigation. X-rays of the mastoids and petrous bones should be done if a deep source for the discharge is suspected. Audiograms are helpful if there is hearing loss. If the discharge is thought to be cerebrospinal fluid, a RISA study and CT scan of the brain may need to be done. An ear, nose, and throat specialist should be consulted before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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