Management of discharging Ear

Scope

Patients with discharging ear (mucopurulent) secondary to tympanomastoid pathology.

Out of scope

Otitis externa.

Assessment

History and Examination

  • History of grommet implantation/ previous surgery
  • Known chronic ear disease +/- perforation
  • Acute suppurative otitis media

Signs and Symptoms

  • Discharge
  • Hearing loss
  • Pain
  • Temperature
  • Mastoid swelling or tenderness
  • Imbalance or nystagmus
  • Cranial nerve involvement or evidence of intracranial pathology (e.g. delirium)

Differential Diagnoses

  • Otitis media
  • Otitis externa
  • Foreign body (consider toddlers or any age with learning disabilities)

Red Flag

  • Severe pain/ cellulitis
  • Suspected intra-cranial sepsis
  • Facial nerve palsy
  • Vertigo

If red flags present refer to on call ENT

Management

Acute suppurative otitis media with perforation (severe pain and temperature followed by discharge and improvement in pain level.)

  • Adults antibiotics/ analgesia - Joint Formulary - ear, nose and oropharynx
  • Children who are otherwise well consider deferred antibiotics
  • Review in primary care at 6 weeks to check ear drum is normal
  • Consider topical quinolone drops if persistent discharge with no other symptoms
  • Continuing discharge or abnormal ear drum at 6 weeks refer to ENT

Chronic suppurative otitis media (chronic tympanic membrane or middle ear disease)

  • Treat according to Joint Formulary - ear, nose and oropharynx
  • Carry out aural toilet or microsuction according to availability
  • Prescribe topical antibiotics and steroid drops and pain killers
  • Give general advice
    • do not poke ears or let shampoo and soap into the ears

If symptoms are unresolved:

  • refer to ENT - see considerations referral

Joint Formulary - ear, nose and oropharynx

Referral

Referral Criteria

  • Any red flags present
  • Persistent discharge despite treatment

All referrals to include:

  • Patient history
  • Treatments already tried, duration tried, side effects, response

Referral Instructions

Referral to ENT

e-Referral Service Selection

  • Specialty: ENT
  • Clinic Type: Ear
  • Service: DRSS-Western-ENT- Devon CCG-15N

Referral Forms

DRSS Referral proforma

Supporting Information

Patient Information

Otitis media patient information leaflet

Glue ear

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.

Publication date: March 2016

 

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