What is the definition of otorrhea?

Otorrhea is the medical term for ear drainage and is also sometimes referred to as “watery ears” or “runny ears”. In many cases, this ear drainage is the result of a ruptured eardrum from an ear infection. This hole in the eardrum allows fluid from your middle ear to drain out into your ear canal. You can develop otorrhea in the left ear or the right ear—or both—depending on the cause of the problem.  

What causes otorrhea?

In most cases, ear drainage is the result of a ruptured eardrum (your doctor might call it a perforated tympanic membrane) from an ear infection. Infections often cause fluid buildup in the middle ear, which can put pressure on the ear drum and cause it to rupture. That rupture allows the fluid to drain out into the ear canal. Other otorrhea causes include:

• Swimmer’s ear (otitis externa)
• Foreign objects in the ear
• Severe trauma to the head or ears

Otorrhea happens most often in children, whose smaller and narrower Eustachian tubes put them at a higher risk of developing ear infections. If a child has chronic ear infections, doctors may place ear tubes into the eardrum to allow air to flow into and drainage out from the middle ear. This prevents fluid buildup behind the eardrums.

In rarer cases, otorrhea can be caused by:

• Cholesteatoma (an abnormal skin growth behind the eardrum)
• Psoriasis
• Fungal infection
• Malignant otitis externa (a complication of swimmer’s ear)

The cause of your otorrhea will determine how it’s treated. Always discuss all of your symptoms with a doctor to determine what might be causing your ear drainage.

Does ear drainage or discharge mean an infection?

Otorrhea is most often the result of a middle ear infection, but ear drainage itself doesn’t always mean that you have an infection. Otorrhea can occur if a foreign object is stuck in the ear, after a head injury, or following improper ear cleaning, or being in water.  

What does ear drainage or discharge look like?

Otorrhea will appear in various colors and textures, depending on the type and cause of the drainage. You may notice it leaking from the ear, or you may notice it dried in the ear canal or on your pillow. Monitor your symptoms by taking note of the color and volume of the drainage, as well as the number of days you notice drainage.

What are the types of otorrhea?

There are several different kinds of otorrhea, depending on the root cause and severity of the problem. Recognizing the signs of the various types of ear drainage can help you determine how to treat otorrhea. The main types of otorrhea include:

• Purulent: this type of discharge contains pus or a cloudy fluid. It’s the most common type of ear drainage and caused by an ear infection.
• Serous: this drainage contains serum, a protein-rich liquid found in the blood. It’s most often caused by an ear infection and is thin and watery.
• Sanguineous or bloody: this ear discharge contains blood. It can be drainage from a minor scratch in the ear, a foreign object in the ear or following an injury.
• Mucoid: this type of otorrhea contains mucus. In most cases, mucoid discharge is caused by blocked Eustachian tubes, resulting in a buildup of mucus in the middle ear.
• Clear: clear or watery discharge, or ear drainage without any visible coloring, can be caused by skin irritation such as eczema.

What are the symptoms of otorrhea?

Otorrhea is a symptom of an underlying problem. However, the drainage may have different characteristics: it may be odorless or have a distinct, foul smell; it may be thick or thin in consistency; and it may be clear, yellow, greenish or bloodied in color. The exact appearance of the ear discharge will vary depending on the cause. Other symptoms that frequently occur along with otorrhea include:

• Ear pain
• Tinnitus
• Itchy ears

More serious accompanying symptoms include:

• Fever
• Hearing loss
• Redness of the skin around the ear
• Vertigo
• Cranial nerve dysfunction

How is otorrhea diagnosed?

To diagnose otorrhea, your healthcare provider will perform a physical exam to determine the cause of your ear drainage. This may include:

• Vitals check for a fever
• Ear canal inspection for drainage, signs of infection or a ruptured eardrum
• Physical check on ears, jaw and neck for swelling or abnormalities
• Skin examination for redness and inflammation

You might also hear your doctor talk about an otorrhea differential diagnosis. It simply means that you have symptoms that match more than one cause or condition, so further testing needs to be done. Some of those additional tests could include:

• Audiograms: This test will measure your hearing range.
• CT scan: This imaging test will determine if the infection has spread beyond your middle ear.
• Cranial nerve examination: This will test your cranial nerves to ensure they’re functioning properly. This test will only be administered if you’ve experienced recent head trauma or you’re having trouble seeing, swallowing or speaking.
• MRI: This magnetic imaging test is used to detect any cerebrospinal fluid leaks. It’s used primarily for those who have experienced recent head injuries.
• Culture: Your doctor may sample your ear drainage to test for any bacteria or fungi growth.

Discuss your symptoms honestly and thoroughly with your doctor during your visits to help them make an accurate diagnosis. Otorrhea can be a sign of numerous conditions, so clear communication about your symptoms can help direct further testing.

How do you prevent otorrhea?

Otorrhea isn’t 100% avoidable, but these small otorrhea prevention steps can help reduce your risk of ear drainage. If your ear drainage is caused by otitis media:

• Seek medical treatment for ear infections
• Wash hands and cover coughs to prevent the spread of germs
• Don’t smoke, and avoid exposure to secondhand smoke
• Stay up to date on vaccinations, particularly for the flu
• Avoid sudden or extreme temperature shifts

If your otorrhea is the result of swimmer’s ear:

• Dry your ears fully after a shower or a bath
• Wear specialized ear protection when swimming to prevent water from entering the ears

When to see a doctor

While otorrhea generally goes away in a few days as an ear infection resolves, schedule an appointment with your physician if your ear drainage lasts more than three days. Meet with your physician as soon as possible if you notice any additional symptoms, including pain, fever or redness around the ears and neck. Your doctor will review your symptoms and provide further treatment recommendations to address the ear drainage.

If you’ve noticed otorrhea following recent head trauma or injury, call 911 or go to an emergency room. Seek immediate care if you’re unable to speak, swallow or see. Otorrhea is a symptom of multiple health conditions, both serious and benign, so immediate conversations with your doctor are important.

When to see a hearing specialist

First consult with your physician and then they will refer you to the hearing care specialist when appropriate. When ear infections are left untreated, they may cause hearing loss.