Q: Hello doc. Thanks for your usual support. What could be the cause of discharge from the ear? It comes and goes like once or twice a year for like five years now. There is neither fever nor pain but a tingling sensation. What could be d underlying problem?
A: Ear infections could lead to discharge of pus from the ear. Examples include:
- Otitis media
- Otitis media with effusion
- Otitis externa (swimmer’s ear)
In otitis media, there is an infection of the middle ear and happens when an upper respiratory tract infection introduces bacteria into the ear. The infection could also be viral. Fluid builds up in the middle ear.
In otitis media with effusion, pus forms as the body tries to fight the infection. This leads to more fluid collection and this pushes against the ear drum. This pressure can build up to the extent that the ear drum ruptures, leading to drainage of pus. With this, the symptoms of pain and problems hearing disappear and the infection clears.
Middle ear infections are common in children between the ages of 6 months and 2 years, children who drink from a bottle while lying down, people who are exposed to tobacco smoke and the infection occurs more during the flu season…when ‘everyone’ is down with a cold or flu. This infection could lead to tearing of the ear drum, hearing problems, spread of infection to surrounding tissues. Most infections would clear up on their own within a week or two, but antibiotics could reduce the duration of symptoms. Be guided by the doctor. Pain medication and a warm compress over the affected ear may help control pain.
In otitis externa, water that remains in your ear for a while can create the sort of moist and warm environment that germs require to grow and multiply. This is very common in people with allergies, swimmers, people who stick their fingers into their ears (yes you! 😀 Don’t look back), use cotton buds (cotton tips) and other objects (tooth picks, pens etc) to clean their ears. The skin of the outer ear canal is very delicate such that sticking things in it to clean it or scratch an itch can lead to bruising making it easy for germs to take over. Young people who use ear phones a lot are at risk of this (for obvious reasons) and also children because of their narrow ear canals. I almost banned y second daughter from swimming because of this. She always got water in her ear while swimming and would be in pain for a while.
Usual symptoms are ear pain, itching, discharge of clear fluid, pain on pulling the outer ear. This may progress to more intense itching, discharge of pus, some degree of temporary hearing loss and may progress to complete blockage of ear canal. This is usually not very serious and resolves with treatment but if complicated may even lead to infections that spread to other parts of the body and could lead to perforated ear drums.
If this infection remains for more than three months, it is then called chronic otitis externa. This can be due to infections caused by a combination of bacteria and fungi, an allergy, a rare strain of bacteria etc
Treatment is usually with ear drops that reduce the swelling in the ear canal, help fight the bacteria or fungi (depending on the infection present) and other medications to fight pain. To help the ear drops make travel to the desired location, trying lying down with the affected ear up.
The Valsalva maneuver is a means of equalizing pressure in the ears by exhaling against a closed mouth and nose. You can try this out when you have ‘airplane ear’. This happens on flights as the planes starts to ascend or begins its descent. Close your mouth, pinch your nose and then try to blow out air against your closed mouth. It works like magic.
I suggest you go see an Ear Nose and Throat (ENT) specialist who will evaluate you. He may take swabs from your ear too to get an idea of what infection is there before proceeding to treat. In instances where treatment has not responded to eardrops, oral antibiotics may be prescribed.
Have a good night, y’all 😀
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