Possible Causes of Ear Discharge

Medically Reviewed By Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP
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Discharge from the ear has a variety of possible causes ranging from mild to serious. Ear discharge is when fluid comes out of the ear canal. The fluid can be clear, yellowish brown, or contain pus or blood.

The most likely cause is an ear infection.

Ear discharge can be mild or very serious depending on where the fluid is draining from and what type of fluid it is. Most ear discharge is treatable and temporary.

Read on to learn more about ear discharge, including possible causes, treatments, and more.

Ear discharge explained

Close-up of person's ear with two cherries hung over ear
Irina Ozhigova/Stocksy United

Ear discharge can come from the outer or middle ear. In addition, cerebrospinal fluid (CSF) can leak from the skull cavity to the outside through the ear. The medical term for ear discharge is otorrhea. Another name for it is drainage, per Merck Manuals and others.

Ear discharge can:

  • be clear and watery
  • be blood tinged or bloody
  • contain pus
  • look like mucus

Healthy ears produce cerumen, commonly known as earwax. Cerumen is a solid substance from the ear that is generally brown to yellow.

Ear anatomy

The ear consists of the:

  • Outer ear: The outer, or external, ear contains the pinna, which is the visible ear, and the ear canal. This is bordered by the eardrum, or tympanic membrane.
  • Middle ear: The middle ear extends from the inner surface of the tympanic membrane to the eustachian tube. The middle ear is filled with air and pressurized by the opening and closing of the eustachian tube, which is connected to the throat. The middle ear also contains the hearing bones: malleus, incus, and stapes.
  • Inner ear: The inner ear holds the cochlea and the semicircular canals that are responsible for balance.

What causes ear discharge?

Some causes of ear discharge are treatable or resolve on their own. Others can cause extensive problems.

Everyday and harmless causes include:

  • water trapped in the ear escaping
  • ear drops escaping

Other causes discussed with more detail in the following sections include:

  • external ear infection
  • middle ear infection
  • necrotizing ear infection
  • ear cancer
  • head injury

External ear infection

Otitis externa is an infection of the external ear, including the ear canal. Bacteria or fungi are the usual causes. A common name for otitis externa is swimmer’s ear, as water in the ear is a risk factor.

Drainage is often copious, thick, and may contain pus or blood. The pinna is painful when gently tugged for examination, and it may be red or swollen. An external ear infection may involve one or both ears.

Treatment for bacterial infections consists of:

  • removing infected tissue and debris
  • for mild infections:
  • for moderate to severe infections:
    • ear wick, a sponge-like material placed in the ear canal followed by antibiotic ear drops
  • for severe infections or infection that has spread:
    • systemic antibiotics, antibiotics by mouth

Over-the-counter (OTC) pain medication can help relieve discomfort. Prescription pain medication may be necessary for severe otitis externa. Clinicians prescribe antifungal medications for fungal infections.

Middle ear infection

Middle ear infection is known as otitis media and can be acute or chronic.

Acute otitis media

A bacterial or viral infection causes acute otitis media, and it is often associated with a recent cold. Acute otitis media generally produces little or no discharge unless the pressure in the middle ear increases to the point that the eardrum ruptures. This causes bleeding. Acute otitis media is painful because of the elevated pressure in the middle ear. Pain usually goes down after rupture.

You can manage acute otitis media with pain relievers and antibiotics. Pain relievers include acetaminophen (Tylenol) and ibuprofen (Advil, Motrin).

Your physician or pediatrician may prescribe antibiotics for a probable bacterial ear infection. However, antibiotics are not necessary for all ear infections, as most go away on their own.

Pain reliever dosing in children depends on the weight of the child. Follow your doctor’s instructions carefully and keep track of the times you give your child medications. Do not give aspirin to a child who has a fever or flu-like symptoms. Aspirin can increase the risk of Reye’s syndrome.

Learn about ear infections in adults, and what to expect after eardrum rupture.

Chronic otitis media

Chronic (suppurative) otitis media involves a perforated eardrum and drainage of fluid from the ear for more than 6 weeks. It is generally painless but accompanied by hearing loss.

The discharge draining from the ear often smells foul and may contain pus.

Treatment includes completely cleaning the ear canal and removing debris and tissue. Surgery may be necessary to remove larger growths. Additionally, doctors prescribe antibiotic or steroid ear drops or both.

Necrotizing ear infection

Necrotizing otitis externa, or malignant otitis externa, is a severe infection of the ear canal and nearby structures. It can spread to bones and cranial nerves as well.

Necrotizing otitis externa is rare. It usually occurs in older adults with diabetes and in people who have low immune system function.

Ear discharge with this condition is yellow or green and foul smelling. There may be increasing pain, especially when moving the head or at night. Other symptoms can include:

Necrotizing otitis externa can spread very quickly, so recognizing it early is crucial.

Ear cancer

Cancers in the ear are rare and may be challenging to diagnose. They include basal or squamous cell carcinomas that originate from the temporal bone in the skull.

Chronic otitis media may increase the risk of squamous cell carcinoma of the ear.

Treatment requires removing the tumor and surrounding tissue. You may also receive radiation. Depending on the amount of tissue removed, reconstructive surgery may be an option.

Benign, or noncancerous, tumors that can rupture and drain include cysts. Surgical removal is the main treatment.

Learn about ear cancer.

Head injury

Head trauma is the most common cause of CSF leaks, if the trauma causes an opening in the eardrum. These leaks may occur immediately after a head injury or may not present until weeks or months later. CSF is clear and watery.

During evaluation of ear discharge, CSF placed on filter paper may show a characteristic halo pattern. This pattern results from blood in the CSF traveling to the outer edges of the stain. Other tests are necessary to confirm the result, followed by imaging to determine the underlying cause.

A headache may accompany a CSF leak. CSF may also drain from the nose depending on the affected tissues.

When should you see a doctor?

Contact a doctor if ear discharge is accompanied by pain or is thick, greenish, yellow, foul smelling, or bloody.

Any head injury with leaking of clear fluid from the ears or nose requires an immediate evaluation. Seek emergency care by calling 911.

Other symptoms that accompany ear discharge

Symptoms that may occur alongside ear discharge include:

  • tinnitus, ringing in the ears
  • vertigo
  • hearing loss
  • itching inside the ear
  • a feeling that something is in the ear
  • discoloration
  • fever

How do you diagnose ear discharge?

Diagnosing ear discharge requires a physical exam. Your doctor will take a detailed history. Be sure to tell them about any head injury, even if it did not happen recently.

Your doctor will ask about symptoms accompanying the ear discharge and assess your cranial nerve function. These nerves are responsible for your senses, certain movements, and more.

Your doctor will examine your ear inside and out. If fluid is present, the doctor may take a sample for laboratory analysis. This may include cultures of the fluid to determine the nature of any organisms that may be infecting your ear.

You may need a hearing test and audiogram.

If your doctor suspects a CSF leak or necrotizing otitis externa, they may order imaging such as an MRI scan. This will show evidence of head trauma or infection invading structures near the ear.

In the rare event that your doctor suspects cancer, they may perform a tissue biopsy. This will help them identify the type and stage of the cancer.

What is the treatment for ear discharge?

Treatment of ear discharge depends on the nature and amount of the discharge, and the underlying cause. Mild otitis media may get better on its own, so your doctor may opt for watchful waiting.

Medications may include:

  • pain relievers
  • antibiotics
  • antifungals
  • steroids

Necrotic otitis externa requires systemic antibiotics and may also require surgery.

Ear cancer may require surgery. Removal of areas of tissue surrounding the site will ensure that diseased tissue is entirely removed.

Other frequently asked questions

Nicole Aaronson, M.D., FAAP, reviewed the following questions.

What color is ear infection discharge?

Ear infection discharge is likely to be yellow or greenish yellow. It could be blood tinged or pink if the eardrum is perforated as well.

Why do my ears feel wet and itchy inside?

You could have an ear infection with discharge, especially if your ears hurt or you have hearing loss. You could also have water from a pool or bath trapped in your ear, and it will resolve in time. Eczema in the ear canal can also cause itching.

Summary

Ear discharge can signal infection, which may range from mild to very serious. Thick or greenish-yellow discharge with a foul odor likely indicates an infection. Clear discharge could also indicate a CSF leak from inside the skull, or in rare cases, cancer.

Contact your doctor if you have pain that you cannot manage with OTC pain relievers or that occurs with vertigo or tinnitus.

Inform your doctor if you have had a head injury, even if it was not recent.

Treatment depends on the underlying cause. Most causes of ear discharge are treatable.

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Medical Reviewer: Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP
Last Review Date: 2022 Oct 27
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