Presentation: Ear Discharge

Systematic approach (anatomy-based)

Working from outer to inner ear helps localise the source: outer ear/canal causes (otitis externa, furuncle, foreign body, eczema) vs middle ear causes via a perforation (acute or chronic suppurative otitis media, cholesteatoma) vs skull base causes (CSF otorrhoea from temporal bone fracture — clear, often unilateral, worsens with positional change or Valsalva).

Red flags: meningism; facial weakness; other cranial nerve dysfunction — these suggest spreading infection (e.g. necrotising otitis externa, intracranial extension) and need urgent assessment.

Imaging thresholds: CT for refractory discharge or associated hearing loss (assess for cholesteatoma/bony erosion); MRI if a CSF leak or malignant (necrotising) otitis externa is suspected.