Doorway: Causes, Symptoms, Diagnosis and Treatment

Several of the most common causes of its manifestation are several types of infection, the access of an unknown object to the ear and a trauma in the brain for example.

Otorrhea is the medical term given to the secretion or drainage of the ear. To diagnose the cause of this drainage, it is very important to know how long it has been happening, how serious it is and exactly in the circumstances in which it started.

Adult otorrhea is not seen as commonly as in the pediatric population, but its complications can be devastating.

More often, otorrhea in adults is secondary to trauma, but other etiologies such as infection should also be ruled out.

The various problems that cause it will normally produce different types of drainage. Normally, the treatment of the otorrhea will depend on the reason for drainage.

The causes of this drainage can start from the ear canal, the middle ear or the cranial vault. The definite reasons tend to be evident due to the implacability of their signs or related conditions.

Additional reasons usually have a continuous, continuous course, but can often become acutely visible.

Causes

Normally, an infection of the middle ear will cause drainage of the ear. This is also known as otitis media and this type of infection can cause the middle ear to become inflamed, usually due to a viral or bacterial infection.

This condition is more common in children and usually causes a thick mucus similar to that of a glue that increases in the middle ear. This increase in mucus can cause the rupture of the eardrum .

When this happens, it is very likely that the drainage of the ear takes place, since the mucus will drain from the eardrum and out of the ear.

A frequent additional reason for otorrhea may be caused by an infection of the outer ear. This is usually referred to as otitis externa. This type of infection is usually recognized as “swimmer’s ear”.

With this infection, the outer segment of the ear becomes inflammation. Several of the most general causes of this type of swelling are excess water, a circumstance of skin and warm weather, which can disturb the skin of the outer ear.

The otorrhea, which can be experienced in any type of ear infection, can result in a clear and watery drainage or drainage filled with pus. A clear, watery drain is usually a thin discharge that is mostly clear in appearance.

In some people, they may also experience drainage filled with pus, which is usually seen in the case of otitis externa.

This type of drainage can create a discharge of unpleasant, thick, yellowish or greenish odor. Some other signs that may accompany an infection that causes discharge may include severe earache, fever, dizziness, nausea, and fatigue.

There are also additional conditions that can cause otorrhea. An impediment in the ear canal can cause this to happen. This can happen due to the insertion of any kind of foreign object into the ear, where it can cause a lot of inflammation.

There are also incidences where a discharge to the ear can occur in the event of a brain injury. If the brain is severely injured, brain fluid can drain through the ear and this is, of course, a very urgent situation.

Several of the fundamental causes of otorrhea are the following:

  • By contact with water due to swimming.
  • Severe blow to the ear in case of a head injury.
  • Wound the ear tissue due to different pressures.
  • Perforation of the eardrum.
  • Dermatitis of the ear canal.

Symptoms of the Otorrea

  • Vertigo or instability.
  • Discomfort or pain in both or in one ear.
  • Mild or partial hearing loss
  • Sensation that the ear is covered.
  • Pressure that is constant in the ear.
  • Nosebleed.

Diagnosis

  • Inspection of the external ear and the canal.
  • Palpation of the mastoid bone.
  • Palpation of the neck.
  • Tympanic membrane inspection.
  • Air insufflation in the canal to document the proper movement of the tympanic membrane.
  • A neurological examination is appropriate in toxic patients and in those patients who complain of a headache or a history of trauma.

Treatment of the Otorrea

First, the doctor should evaluate the occurrence of otorrhea with the suction device to clear this discharge in the affected ear. After this, the doctor can establish the exact site where the discharge comes from.

It will be recommended the use of antibiotics that are topical, as well as the obligation not to wet the ear, as well as to avoid swimming until the end of the complete treatment. The individual should not wash their ear with water to clear the discharge, as this will force the eardrum and may cause it to perforate.

The use of antibiotics should be withheld until a lumbar puncture is done to confirm any signs of meningitis . A “trans-canal” method to treat otorrhea is also suggested. On the other hand, a “transmastoid” method is preferred in the case of a natural discharge, since the exact location of the leak is unknown.

The treatment requires surgical intervention and long-term antibiotics. In the context of an isolated service station or a small boat, the patient should receive medical attention as soon as possible for a definitive diagnosis and treatment.

If immediate transfer of the patient is not feasible, empirical antibiotic therapy should cover P. aeruginosa, S. epidermidis, Aspergillin: Ticarcillin, Piperacillin or Ceftazidime with an aminoglycoside are the drugs of choice.

However, remember that this entity needs surgical intervention and long-term antibiotics (for at least six weeks), so patient transfer is a priority.

Otitis media suppurativa:  Middle ear infection with drainage of pus through a perforated tympanic membrane. The patient will initially complain of severe otalgia that suddenly improves after throwing out some discharge from the ear.

The offending organisms are S. aureus, P. aeruginosa and enteric Gram-negative bacteria such as Klebsiella, E. coli and Proteus. Fifty percent of patients will also have anaerobic organisms such as: Prevotella, Fusobacterium, Porphyromonas and Bacteroides.

The treatment consists of oral antibiotics specifically directed to the responsible organism after identification with cultures has been achieved. Empirical treatment can be started using Amoxicillin 500 mg orally 12 hours or Augmentin 500 mg orally every 12 hours.

It is also important to perform a computed tomography to rule out cholesteatoma and mastoid kidnappings that require surgical drainage.

Perforation of the tympanic membrane:  A perforated tympanic membrane can occur with or without discharge from the ear. Those presenting with otorrhea are most likely infected secondarily with bacteria, and cultures should be taken immediately.

Treatment with antibiotics is directed to the identified pathogen. It is important to evaluate the acuity of the hearing to rule out damage to the ossicles.

Sensorineural or ear hearing loss suggests that a portion of an ossicle or a missile has been inserted into the inner ear or that there is a fistula between the perilymphatic space of the vestibule and the middle ear.

These conditions require a surgical intervention, therefore, the patient must be transferred to a center with subspecialty surgical capabilities, however, this does not have to be done in an emergent manner.

The vast majority of perforations of the tympanic membrane heal spontaneously within six weeks.

During this period, the patient should be advised not to place any instrument in the ear, such as swabs with a cotton tip, and to avoid the introduction of water or other liquids.

If desired, coverage with oral penicillin for seven days may be recommended.

Bleeding from the ear:  Bleeding from the ear after a head injury is a very ominous sign. When the bleeding comes from the middle ear, it is a sign of a fracture of the temporal bone skull.