Ear Discharge (Otorrhea): What It Means and What to Do

What ear discharge means by type

Causes of pus discharge from the ear

Middle ear infection with a burst eardrum

In acute otitis media, pus builds up behind the eardrum, causing severe pain and often fever. The pressure can tear a small hole in the eardrum, and pus drains out. Pain usually eases quickly once it bursts. This is most common in young children after a cold. Most small tears heal on their own within weeks.

Ear canal infection (otitis externa)

Swimmer's ear is an infection of the skin lining the ear canal. Water, scratching, cotton swabs, earbuds and hearing aids damage the skin and let bacteria in. Typical signs are itching, then pain that worsens when you pull the outer ear or press on the flap in front of it, a swollen canal, and watery or pus discharge. Hearing may be muffled.

Chronic suppurative otitis media

A long-standing hole in the eardrum with repeated or constant discharge, often painless, for more than 2 weeks. It is linked with hearing loss. See chronic otitis media.

Cholesteatoma

A cholesteatoma is a growth of skin cells in the middle ear behind the eardrum. It causes a persistent, often foul-smelling discharge from one ear and gradual hearing loss. It slowly erodes bone and needs surgery.

Ear tubes (grommets)

Children with ventilation tubes can get discharge through the tube when they have an ear infection. It is usually treated with antibiotic ear drops rather than oral antibiotics.

Other causes of ear discharge

• Fungal infection: itching, fullness and white, gray or black debris, often after antibiotic drops or in humid climates.
• Eczema or seborrheic dermatitis of the canal: flaky, weepy skin.
• Injury: a cotton swab, a slap to the ear, a blast, or barotrauma from flying or diving can tear the eardrum, causing bleeding and sudden hearing loss.
• Foreign body: in children, a bead or insect in the ear can cause smelly discharge.
• Malignant otitis externa: a severe infection spreading into the skull base, mostly in older adults with diabetes. It causes deep, severe pain, discharge, and sometimes facial nerve weakness.
• CSF leak: rare. A clear, watery discharge after a head injury or ear surgery.

Is ear pus discharge serious?

Most ear pus comes from common infections that respond well to treatment. Complications are uncommon but include mastoiditis (infection of the bone behind the ear), facial nerve palsy, hearing loss, and rarely meningitis or brain abscess. That is why discharge with fever and swelling behind the ear, facial weakness, or severe headache needs urgent assessment.

How doctors diagnose the cause

A doctor will look into the ear with an otoscope, gently clean away discharge (sometimes by suction) to see the eardrum, and check whether pulling the ear hurts. They may:

• swab the discharge to identify bacteria or fungus, especially if it keeps returning
• test hearing
• arrange a CT scan if cholesteatoma, mastoiditis or malignant otitis externa is suspected
• test clear fluid for a protein found only in spinal fluid (beta-2 transferrin) after a head injury

Ear pus discharge treatment

• Antibiotic ear drops: the main treatment for swimmer's ear and for discharge through a perforated eardrum or ear tubes. Use only drops your clinician says are safe for a perforated eardrum, such as ofloxacin or ciprofloxacin. Some drops, including those containing aminoglycosides, can damage hearing if the eardrum is open.
• Ear cleaning (aural toilet): removing discharge lets drops reach the infection.
• Wick: a small sponge placed in a very swollen canal to carry drops in.
• Oral antibiotics: for acute otitis media in young children or severe infection, spreading infection, or people with diabetes or weak immunity.
• Antifungal drops for otomycosis.
• Surgery: for cholesteatoma, and to repair an eardrum hole that does not heal (tympanoplasty).

Home care

• Keep the ear dry: use a cotton ball coated with petroleum jelly in the outer ear when showering, and avoid swimming until it heals.
• Gently wipe discharge from the outer ear only. Do not push cotton swabs into the canal.
• Lie with the affected ear facing down to help drainage.
• Use acetaminophen (paracetamol) or ibuprofen for pain, following the label dose.
• Do not put oils, garlic, hydrogen peroxide or other home remedies into a draining ear.

Frequently asked questions

What is the medical term for discharge of pus from the ear?

The medical term for any ear discharge is otorrhea. Pus discharge is sometimes called purulent otorrhea. When it comes from a long-standing middle ear infection through a hole in the eardrum, it is called chronic suppurative otitis media.

What causes pus to come out of the ear?

Pus usually means a bacterial infection: either of the ear canal skin (swimmer's ear) or of the middle ear that has burst through the eardrum. Less often it comes from a long-term eardrum hole, a cholesteatoma, an infected ear tube or a foreign object in the ear.

How is ear pus discharge treated?

Most ear pus is treated with antibiotic ear drops for 7 to 10 days, along with gentle cleaning and keeping the ear dry. Oral antibiotics are added for young children with middle ear infections or for severe or spreading infections. Discharge lasting over 2 weeks needs an ENT specialist.

Is ear discharge contagious?

The discharge itself is not usually considered contagious, but bacteria in pus can spread to other surfaces. The colds that often trigger middle ear infections are contagious. Wash your hands after touching the ear or discharge.

Will my hearing come back after a burst eardrum?

Usually yes. Most small eardrum tears heal on their own within about 6 to 8 weeks, and hearing returns. Keep the ear dry while it heals. If hearing has not improved by then, or discharge continues, see an ENT specialist.