Drainage from the ear can originate from any of three sites—the external ear, the middle ear, or the brain. In analyzing otorrhea, several factors are important to consider, including the appearance of the discharge, the pattern of the discharge, and the chronicity of the discharge. The appearance of otorrhea can vary significantly. Otorrhea can take the form of purulent fluid as is the case in middle and external ear infections; clear, noninfected fluid as is seen in a cerebral spinal fluid (CSF) leak; or bloody as can be seen with infections or trauma. The pattern of the discharge is another important factor in diagnosing and treating this disorder. Discharge can be constant as is often seen with infectious etiologies or intermittent as can be seen with tympanostomy tube otorrhea. Additionally, the discharge can sometimes be observed to vary in intensity with pressure, as can be seen with CSF otorrhea. Finally, otorrhea can be described by the length of its course as acute or chronic. Arbitrarily, we label otorrhea lasting less than six weeks as acute and that lasting more than six weeks as chronic. While this time course may be a helpful diagnostic sign, intervention may affect time course as much as the etiology affects time course. A chronically draining ear may be from a middle-ear cholesteatoma or may simply be from untreated otitis externa. One etiology, otitis externa, may have resolved with antibiotic therapy, had it been treated, whereas the other, cholesteatoma, may have gotten better but not resolved with antibiotics. Therefore, knowledge of what treatment was applied and when it was applied is very important in using time course as a factor in determining etiology.
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