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Ear discharge

  • Common ddx

    • otitis externa (swimming, pain on tugging ear)
    • otitis media with rupture
    • chronic otitis media
    • wax (painless, asymptomatic except discharge)
    • cholesteatoma (whitish debris in discharge)
  • Serious ddx

    • basilar skull fracture (clear discharge, trauma)
    • mastoiditis (mastoid tenderness)
  • Labs

    • CBC
    • smear, culture, sensitivity
    • xray if suspect mastoiditis
    • CT if suspect basilar skull fracture
  • HPI

    • onset
    • triggering event
    • quality of discharge: clear, bloody, waxy
    • quantity of disharge
    • aggravates, alleviates
    • associated pain
  • ROS

    • fever, rash, trauma
    • headache
    • vertigo, tinnitus, hearing loss, earache
    • chest pain, dyspnea
    • nausea, vomiting, diarrhea, abdominal pain
  • PMH

    • chronic otitis media
    • ciliary dyskinesia
    • kartagener's
  • FH

  • SH

    • swimming
  • Meds

  • Allergies

  • Px

    • vitals
    • gen impression
    • head, eyes: trauma, ecchymosis, nystagmus
    • inspection: erythema, discharge (clear, blood-tinged, mucopurulent, waxy, with white debris)
    • palpation: pain on tugging, mastoid tenderness
    • otoscope: ear drum (intact vs ruptured), cholesteatoma
    • cardio, pulm, abd
    • gait
  • Tx

    • otitis media: amoxicillin 90mg/kg/day vs. observation if really mild
    • otitis externa: clean out canal, give ear drops (cortisporin)

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.