The nature of the discharge should be characterized as:
(1) bloody
(2) purulent
(3) clear or serous
(4) cerumen (wax) from the ear
(5) with necrotic or cellular debris
(6) with malignant cells
Other features of the discharge to note:
(1) unilateral or bilateral
(2) volume in mL
(3) timing - constent or intermittent
(4) precipitating factors
(5) other features such as odor
Causes of otorrhea include:
(1) hemorrhage from the middle or external ear canal, either associated coagulopathy, vascular malformation, and/or trauma/surgery
(2) cerebrospinal fluid (CSF) leakage following basal skull fracture
(3) acute or chronic otitis media
(4) otitis externa
(5) dermatologic conditions of the external ear canal such as psoriasis, atopy or eczema
(6) drainage following rupture of the ear drum (tympanic membranes)
(7) cholesteatoma
(8) mastoiditis
(9) localized boil or abscess in the external ear canal
(10) fistula (salivary, branchial)
(11) vasculitis involving the middle ear (Wegener's other)
(12) eosinophilic granuloma
(13) cancer involving or extending to the middle ear or external ear canal
(14) radionecrosis
