Pus Draining from the Ear

What pus from the ear means

Healthy ears make wax, not pus. Wax is sticky and tan, brown or orange. Pus is thicker and creamy, and it is yellow, green, white or gray. It is made of white blood cells, bacteria and debris, and shows that your body is fighting an infection in the ear canal or behind the eardrum.

Doctors call any ear discharge otorrhea. When it contains pus, it is purulent otorrhea. The color, smell, timing and accompanying symptoms help pinpoint where it comes from.

Common causes of pus draining from the ear

Middle ear infection with a burst eardrum

The most common cause, especially in children. In acute otitis media, pus builds up behind the eardrum. Pressure rises and the ear becomes very painful, often with fever. If the pressure is high enough, the eardrum tears and the pus drains into the canal.

The typical story: a day or two of worsening earache, then sudden relief of pain as the ear starts to run. The discharge may be blood-tinged at first. The small hole usually heals by itself within a few weeks once the infection clears.

Swimmer's ear (otitis externa)

Otitis externa is an infection of the skin of the ear canal, often after swimming, showering, using earbuds or scratching with cotton swabs. Clues that point to the canal rather than the middle ear:

• pain when you pull on the outer ear or press the small flap in front of the canal (the tragus)
• an itchy, swollen canal
• discharge that may be thin at first, then thick and yellow or white
• no recent cold and usually no fever

Fungal infection of the canal can produce white, gray or black fuzzy debris and intense itching.

Ear tube drainage

Children with ear tubes (tympanostomy tubes) commonly get drainage when they have a cold or get water in the ear. The tube lets pus drain out rather than building up, so these episodes are usually less painful. Antibiotic ear drops are the first treatment.

Chronic suppurative otitis media

This is a long-standing hole in the eardrum with discharge that keeps returning or lasts more than 2 weeks. It is usually painless. The discharge comes and goes, often after colds or water exposure, and hearing is reduced on that side. See chronic otitis media.

Cholesteatoma

A cholesteatoma is a growth of skin cells behind the eardrum. It slowly erodes the tiny hearing bones and nearby bone. Warning features are persistently foul-smelling discharge from one ear, gradual hearing loss on that side, and discharge that keeps coming back despite drops. It needs surgery, so long-lasting smelly drainage should always be checked by an ear, nose and throat (ENT) specialist.

Other causes

• Foreign object: a bead or piece of cotton in a child's ear can cause smelly, one-sided pus.
• Infected ear piercing or boil: a tender lump in the outer ear or canal that bursts.
• Malignant (necrotizing) otitis externa: a severe, spreading canal infection in older people with diabetes or a weak immune system. Pain is severe and constant, often worse at night.
• Skin conditions: eczema or psoriasis in the canal causes weeping and crusting that can become infected.

Ear discharge by color and type

Symptoms that often come with it

• Ear pain: severe pain that suddenly eases as the ear starts to drain points to a burst eardrum.
• Hearing loss: muffled hearing is common and usually temporary. Hearing that does not recover needs a hearing test.
• Fever: more typical of middle ear infection than swimmer's ear.
• Ringing or dizziness: mild symptoms are common. Severe vertigo suggests the inner ear is involved.
• Swelling behind the ear: a red, tender swelling over the bone behind the ear suggests mastoiditis, which needs same-day assessment.

How doctors find the cause

A doctor will ask when the drainage started, whether pain came first, about swimming, cotton swab use, ear tubes, previous infections, diabetes and hearing changes. They then:

1. Look in the ear with an otoscope after gently cleaning out the discharge (sometimes by suction). This shows whether the canal is swollen and whether the eardrum has a hole.
2. Swab the discharge if it is persistent, recurring, or not responding to treatment, to identify the germ and the best antibiotic.
3. Test hearing if drainage is chronic or hearing has not recovered.
4. Order a CT or MRI scan if cholesteatoma, mastoiditis or a spreading infection is suspected.

Treatment for a draining ear

Medical treatment

• Antibiotic ear drops are the main treatment for swimmer's ear, tube drainage and most cases of chronic discharge. When the eardrum may be perforated, doctors use drops that are safe for the middle ear, such as fluoroquinolone drops, rather than aminoglycoside drops, which can damage hearing.
• Oral antibiotics are used for acute middle ear infection, especially in young children, with high fever, or when infection is spreading.
• Ear cleaning (aural toilet): a clinician removes pus and debris so drops can reach the infection.
• A wick: if the canal is very swollen, a small sponge is placed to carry drops inside.
• Surgery: repair of a hole that does not heal (tympanoplasty), or removal of cholesteatoma.

Home care while it heals

• Keep the ear dry. Use a cotton ball coated with petroleum jelly in the outer ear when showering, and avoid swimming until a doctor says it has healed.
• Wipe discharge from the outer ear only. Do not push cotton swabs into the canal.
• Lie with the affected ear down to let it drain.
• Take acetaminophen (paracetamol) or ibuprofen for pain at the label dose. Do not give aspirin to children or teenagers.
• Do not put oils, garlic, hydrogen peroxide or home remedies into a draining ear. If the eardrum is torn they can reach the middle ear.
• Finish the full course of drops, even once the ear feels better.

Preventing repeat infections

• Dry ears after swimming by tilting the head and using a hair dryer on a low, cool setting held well away.
• Consider earplugs for swimming if you have ear tubes or a known perforation.
• Avoid cotton swabs and scratching the canal.
• In children, keeping up with pneumococcal and flu vaccines and avoiding cigarette smoke lowers the risk of middle ear infections.

Frequently asked questions

What does it mean when pus is coming out of your ear?

It usually means an infection. Most often a middle ear infection has burst the eardrum, letting pus drain out, or the ear canal itself is infected (swimmer's ear). Both are common and treatable, but a doctor should look in the ear to decide which drops or antibiotics are needed.

Is ear drainage good or bad?

Drainage after a painful ear infection often brings quick pain relief because the pressure is released. It still needs treatment. Most small eardrum tears heal on their own within weeks, but persistent drainage, smelly discharge or worsening symptoms need a doctor.

How long does ear drainage last with an infection?

With treatment, drainage from a burst eardrum or swimmer's ear usually slows within 2 to 3 days and stops within about a week. Drainage that lasts more than 2 weeks is called chronic and should be checked by an ENT specialist.

Can I put drops in a draining ear?

Only drops that a clinician has recommended. If the eardrum has a hole, some drops can reach the inner ear and harm hearing. Doctors choose drops that are safe for a perforated eardrum. Avoid oils and home remedies in a draining ear.

Why does the discharge from my ear smell bad?

A bad smell suggests bacteria in long-standing infection. It is common in chronic otitis media and is a key warning sign of cholesteatoma, a skin growth behind the eardrum that needs surgery. Any persistently smelly ear discharge should be examined.

When should a child with ear drainage see a doctor?

Any child with ear drainage should be seen within a day or two, and the same day if under 6 months old, if they have a high fever, swelling behind the ear, a stiff neck, unusual drowsiness or a weak face.