Causes of Ear Discharge (Secretion, Fluid)

Blood, fluid and other secretions from the ear is known as otorrhea or commonly referred to as ear discharge. In otorrhea, the discharge exits through the ear and should not be confused with natural ear wax (cerumen) that occurs within the ear canal. Ear discharge should not be ignored, especially if there is  constant secretions of blood, discharges stained with blood or clear, thin or sticky fluid that may be cerebrospinal fluid (CSF).

Types of Ear Discharge

There are different types of ear discharge that can often be identified by the color, viscosity (fluid ‘thickness’) and odor. Broadly, ear discharge could be characterized as serous discharge that is clear and thin which may be the tissue fluid, bloody discharge or purulent discharge due to infection, which may vary from yellow to brown.

  • Foul smelling discharge from the ear is usually a sign of infection or cholesteatoma. Refer to Smelly Ear.
  • Yellow or brown fluid is also a sign of infection and in persistent infections, the discharge may be stained with blood and is usually thick and sticky. In acute infections, the ear secretion may appear white.
  • Bloody discharge, especially of ‘fresh’ blood, indicates a rupture of microvessels of the middle or inner ear or more serious causes of bleeding within the cranial cavity.
  • Clear discharge, sometimes referred to as watery ear discharge, may be an indication of tissue swelling or more seriously, cerebrospinal fluid which is the fluid that surrounds the brain in the cranial cavity.

Signs and Symptoms associated with Ear Discharge

Ear discharge may occur without any signs or symptoms, however, most causes of ear secretions will also result in symptoms due to pathology of the affected area.

Causes of Ear Discharge

The most common causes of a ear discharge is due to an infection of the outer or middle ear although otorrhea is also present in severe head trauma.

Acute Otitis Media

Acute otitis media where a perforation of the ear drum (tympanic membrane) is present may result in ear discharge. Severe pain of the ear usually occurs due to swelling and pressure caused by the purulent discharge. The pain usually precedes the discharge and may be accompanied by other symptoms like a sore throat, red eyes (conjunctivitis), fever, diminished hearing and at times, jaw pain.

Children with acute otitis media also present with restlessness, irritability, loss of appetite and may be seen constantly interfering with the ear. Recurrent bouts of acute otitis media should be investigated and appropriate long term treatment and preventative measures should be implemented.

Treatment

  • Antibiotics may be necessary for bacterial infections, which is the most common cause of infection in acute otitis media.
  • Anti-inflammatory drugs will reduce any pain and swelling and corticosteroids may be necessary in severe cases of swelling which is not resolving with anti-inflammatory drugs.

Chronic Otitis Media

Chronic otitis media may result in a persistent ear discharge and some of the other symptoms of an acute otitis media may not be present. Usually the discharge is yellow to brown and has a foul odor and can affect hearing and balance or may be reported as dizziness. Chronic otitis media is also called ‘glue ear’ due to the thick, sticky discharge.

Treatment

  • Antibiotics may be necessary for long standing bacterial infections.
  • Corticosteroids may be necessary to reduce swelling and secretions.
  • Grommets may be inserted and this may also be necessary in children experiencing recurrent bouts of acute otitis media.

Cholesteatoma

A cholesteatoma is when a keratin mass occurs in the middle ear. It can block the eustachian tube, damage surrounding tissues and increase the risk of chronic otitis media. Retraction (not perforation) of the ear drum allows the discharge to empty through the ear canal. A chronic, offensive smelling ear discharge that is scanty may be a sign of a cholesteatoma. Initially it may be painless pain can set it as the condition progresses.

Treatment

  • Surgery is usually necessary.

Severe Head Injury

Head trauma, especially in cases of  hard falls, severe assault or motor vehicle accidents, may result in otorrhea. This may be seen as a clear fluid usually due to a CSF leak, or blood stained fluid or in severe cases, profuse bleeding.

Treatment

  • Severe head trauma requires immediate medical treatment and should be treated as a medical emergency especially if there is a concurrent discharge of blood or fluid from the nose (nosebleed).
  • A CT scan is necessary and the attending physician will decide on the appropriate treatment based on the findings.

Otitis Externa

Otitis externa is an inflammation of the external ear (pinna) and ear canal caused by infection or an allergic response. The most common symptoms include pain, itchy and swollen ear canal. Otitis externa due to infections is also known as swimmer’s ear and is common during the summer ‘swimming’ season.

Treatment

  • Antibiotics is required for bacterial infections. A viral or fungal infection causing otitis is less common but appropriate treatment should be implemented if necessary.
  • Antihistamines are usually required in otitis externa due to allergies.
  • Corticosteroids ear drops may be used to reduce swelling and itching of the ear canal in severe cases, provided that the ear drum is not perforated.

Other less common causes of chronic ear discharge include :

  • Cancer of the ear canal or tumour in the middle ear.
  • Mastoiditis which is an infection of the mastoid process of the skull which is located behind the external ear. This infection may occur due to otitis media where the infection spreads to the mastoid process. It may be seen as a swelling behind the ear or reported as pain behind the ear.
  • Foreign body in the ear usually occurs in children inserting objects in the ear. The object causes swelling of the ear canal and bacterial infections may occur further down the canal leading to foul smelling discharges.
  • Necrotizing otitis externa is a complication of otitis externa that is rare. The infection spreads to the bones of the skull and chronic severe pain is usually present. This condition usually occurs in immunocompromised or diabetic patients.
  • Wegener’s granulomatosis is a rare condition that affects the blood vessels of the respiratory passages, ears and less commonly, other areas of the body.

References

1. Acute Otitis Media. National Guideline Clearinghouse

2. Swimmer’s Ear. Mayo Clinic

3. Mastoiditis. Medline

4. Necrotizing (Malignant) External Otitis. American Academy of Family Physicians

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  • Angel N Brian

    hi I wanted to ask a question. I
    have a 3 year old grand daughter who had tubes put in about maybe 1 – 2 years ago. For about a month now she has had bleeding in one of her ears and has a fowl smell. We contacted the doctor and they said maybe her tube fell out.im concerned because its sometime old dry blood but also last night it was fresh brite red blood. Taking her to doctor today but im worried it is something serious.

  • Hi Angel. Hopefully it has resolved by now. If she is not seeing an ENT specialist (otorhinolaryngologist) then you should consult with one. It is unlikely that the tubes are still in place from 2 years ago and this could be an entirely new problem. A follow up consultation, preferably with an ENT specialist, would be advisable at this point. Do not delay because depending on the underlying condition it can progress to complications and affect her balance and hearing in time.

  • fran

    I have the same thing. I had a horrible cold which I got a bad ear infection. My ears popped and fluid has been running out since. That was almost 7 yrs ago. I went to ear cuz the pain in my ears got so bad. They did ct scans x rays all that to no avail. When my allergies act up it gets worse and i have to put cotton balls in them to keep from draining on my clothes. It creates sores in my ears alot. It itches none stop when it starts to drain. They gave me a 3 in one ear drop at er that I use when it gets really bad. It’s a fungal eardrop. It works for a few days. I purchased an occasional ear drop that’s home patio from Dg in rexall brand that helps on days when it’s not to bad. My right ear drains the worst. I’ve had several drs ck it out over the 7 yrs but no one knows what it is.

  • Krystian Eguridu

    hello…am having similar problem as that of tennille, mine started 2years ago. yellow fluid coming out of my ear but not itching me though. can you prescribe anything for me please?

  • renee

    Hi,I my right ear has fluid coming out been like that for 3days now I’ve been to see doctor was given antibiotics but now I’m feeling numbness in my left side of face …

  • Steven Shepard

    Well my right ear has been draining for at least a month now if not longer. Sometimes it’s clear and sometimes it’s a light yellow. Don’t really have a bad smell, it has a little bit of a smell sometimes and there has not been any pain whatsoever thus far. Can anyone tell me what might be going on?

  • Steven Shepard

    Well my right ear has been draining for about a month now or a little longer. The fluid is clear sometimes and sometimes it is a light yellow with hardly a smell to a little bit of a smell. No pain whatsoever thus far. Can anyone tell me what is possibly going on? Is it infected? Just curious, please someone help me out.

  • shashi

    I m 69 yes old lady ,I have ear leakage in a very mild form. I got ear operated in 1985 ,since then no problem I faced. Only few days ago this leakage from the same operated ear has started .It is sticky and white little pale . Please reply and suggest too .

  • HI Renee. It’s very important that you follow up with the doctor if you have not done so as yet. It seems your conditions is progressing and can lead to severe complications if left untreated. Do not try to self-manage the condition. Speak to a doctor ASAP.

  • Krystal

    Hi, I’ve had an ear issue for about two weeks now. I can’t ear out of my right ear. I did the basic stuff at first thinking it was

    Just water from showering or maybe a minor ear infection. Well now I’m worried I tried cleaning it out with tissue and I got this dark discharge kinda the consistency of eye boogers and also what looked like skin but a grayish color. It does hurt sometimes unbearable. Any ideas?? I do not have insurance so I’m trying whatever I can before racking up a large bill. Thank you

  • Randy

    I have a very bad drainage from my left ear it smells like something dead it itches a lot and at night it drains worse I have ringing in my ear and been light headed and dizzy I have had problems with my left ear for as long as I can remember it’s driving me crazy I need help with what I should do about finding out what it is

  • Pranay Sharma

    Hloo sir,
    From past 25 days when i get upin d morning a hard like material is there in both of my ears..when I clean that a clear fluid starts coming out from both ears.. Also a plasma type yellow fluid i find in d middle of ears when I clean them n has very bad odour…
    One more thing that I was having cold before this problem came into being…
    N
    Today d ENT specialist gave me :-
    1. Lorcin-Bc ear drop
    2.Ferocef O-200 tablets
    3.fexodive-180 tablets

    Will u plz tell me that is the doctor giving me right treatment?

  • Hi Randy. As you can see from the article above there are many possibly causes and this needs to be investigated immediately by a doctor because of more serious symptoms like dizziness. Do not delay. If your family doctor is not able to provide answers you should consult with an ENT specialist (ear/nose/throat or otorhinolaryngologist). The foul smelling discharge on its own is a cause for concern but when combined with the ringing and dizziness, it warrants immediate attention.

  • Rose

    Hi my name is Rose, for the last 8 months or so. My ears drain clear fluid and itch. After it itches and drains, dries a white flaky scale like substance. I do have to say when it drains, the fluid burns because my ear canal is irritated. Sometimes it has a foul smell. Is this fungal or non fungal is my question. Is it allergies? Please help

  • Andrew Min

    hi.

    So I previously had cholesteatoma in my right ear and had a mastoidectomy performed (several years ago). Yesterday, I started to get this clogged feeling as if I had a wax buildup like I did before. The pressure seems to have subsided but I’ve started to get this watery yellow liquid coming out of my ear. It’s not frequent but whenever I tilt my head, I seem to get a little bit of it. What do you think it is? I’m thinking that it’s a wax buildup… but I don’t want to self diagnose too much.

  • Andrew Min

    I had a mastoidectomy to clear out cholesteatoma a few years back and as of yesterday, the ear that had the operation is having an issue. I do have some pressure build up and I’m getting a yellowish fluid coming out of my ear. It doesn’t come out unless I til my head. I did use a qtip and I’m wondering if I went too far and is the cause of this. What do you think?

  • Hi Andrew. This could be a recurrence of the cholesteatoma or it could be an entirely separate ear problem. You should definitely consult with an otorhinolaryngologist (ENT specialist) to verify the cause. There is quite a high risk of cholesteatomas recurring and the only way to be sure is to undergo an examination. Rather not wait any longer and get professional medical advice.

  • Susan

    A couple of years ago I had a recurring ear infection which eventually went away, but ever since I have had thick, yellow, foul smelling discharge from one ear, and some hearing loss. My hearing seems muffled in that ear. Sometimes the ear is itchy. There is no pain or swelling. What could this be?

  • I never had ear wax issues until I did one of those saline nasal flushes and ended up almost deaf in one of my ears. After reading up about the nasal flushes, they are not good for all people. After I got my full hearing back, my ears canals started to get itchy and I’d feel fluid draining from them, coming down to the enterace/exit of the ear. It felt like when your ears get clogged when swimming, then at night u lay down with that ear facing downward, on the pillow, and all of a sudden you feel the fluid drain out and u can hear again. It’s bothers some, so I use the top of my finger with a little tissue paper or paper towel covering it, and yes, I stick it in my ear. Not far, just a very little, and wiggle my finger around, I feel like I look like a dog scratching it’s ears. This actually draws the fluid out onto the paper, like wiping up a spill, it’s absorbed. I have to repeat this a few times, to real feel like my ear canals are drier. This happens at least once everyday. The paper towel is colored lights get yellow, no blood, no green infection. So, I wonder if the nasal flush did something, not necessarily damaged some part of the ear and nose parts, but I feel like it opened something up, allowing was to drain out more. Anyone else have this reaction o the nasal cleanse?

  • Bianca

    My ears itch so bad and they be so sore at times. Now I’m noticing them leaking with a smell it’s been this way for almost 2 years should I go get them checked????

  • Laura Holt

    my son is 8 years old and started bleeding from his ear 3 weeks ago had 3 lots of antibiotics.ear biotics hasn’t cleared up.hes never had any pain with it either. had more leaking out of ear last night with bits of white tissue type in the fluid. can’t see ENT for 2 months but I’m quite concerned as he struggles to hear out of thst ear too.

  • Sarah Richardson

    In 2006 I was taking a scuba diving class and coughed under water pushing water into my inner ears. I had a double ear infection. Ever since I feel like there is glue inside my ear. I was diagnosed with eustation tube dysfunction by azu university. How can I still have this problem 10 years later? There has always been clicking if I swallow from all the glue in there. I stopped going to the ent cause all they do is give me nasal spray. I DONT HAVE ALLERGIES. I moved from up north to south with no change and its year round no change, no sneezing, no itchy eyes. I need help. Can you recommend a GOOD ent doc in az that will help me solve this problem once and for all and do real tests? Not just assume its allergies. Accchs. I also get clear fluid drainage in the morning after I wake up, no color no smell. I get headaches radiating. From where my skull meets my c1. I don’t know if the leakage is from my cerebral fluid, I doubt it but my quality of life is so much worse than before. Everything since is slightly muffled from all the “glue” in there. Help.

  • roseann

    hello my 22 month son had bilateral tubes placed about 6 weeks ago.
    day of surgery he had very bad active bialteral ear infection.
    he was given antibiotic ear drops 10 days bid
    that didnt help, they changed it to ciprodex again 10 days bid
    since this we have been back to ENT, where they suction more puss from both ears, right still being the worse.
    after that he was seen at his pediatrician, aagain for drainage and puss, ears still infected , told to go back on ear drops.
    last night I was cleaning his ears before putting drops again, and noticed both ears crusty, and right ear still has drainage and puss.
    i dont think this is normal !
    Im worried about hearing loss in right ear
    help ?