Causes and Treatment for Ear Drainage

Ear drainage can be a sign of several conditions, depending on what type of fluid is coming from the ear. Discharge from the ear is most commonly ear wax. However, it can also include blood, clear, or milky white liquid. It can also be a combination of these.

Ear wax is yellow to orange-brown in color and is generally not a medical problem. Other types of drainage, however, can indicate conditions that may require medical attention. Not all cases do—familiarize yourself with the different types below to see if you need to be seen by a doctor.

You may notice discharge from your ear if you have any of the following common conditions:

• Ruptured eardrum
• Swimmer's ear
• Foreign objects
• Ear wax
• Dermatitis
• Trauma (blood or cerebral spinal fluid)

Less common causes for experiencing ear drainage include:

• Malignant otitis externa
• Cancer
• Psoriasis
• Polyps
• Fungal infection

In general, you should not worry about any of the above rationales for having fluid draining from your ears. Your doctor, however, will consider these if your ear discharge is not related to a common cause.

Ear wax is the most common substance seen coming from the ear. It is normal for a small amount of ear wax to be seen in the outer ear canal. To keep this at bay, some ENT doctors recommend using a washcloth or tissue over your little finger to clean the outer ear canal only.

Using Q-tips at any time for the removal of ear wax is not recommended. Using a Q-tip can not only push the ear wax in farther but can also cause trauma to the eardrum.

Large amounts of ear wax coming from the ear may indicate a blockage or a problem with ear wax overproduction. If this is the case, the ear wax may be removed by a physician.

Ear drops that can dissolve ear wax may be used if needed. Ear wax can also be flushed out using warm water and a syringe, but this should only be done as instructed by your physician.

In most cases, a ruptured eardrum (or perforated eardrum ) is not a medical emergency; however, it should be checked out by a doctor. The ear drainage in this condition is usually clear but may also be bloody and whitish-yellow. Typically, there is only a small amount of drainage.

The most common causes of a ruptured eardrum include:

• Barotrauma caused by rapid changes in ambient pressure
• Cholesteatoma
• Middle ear infections
• Loud noises
• Trauma, such as a sharp pencil or severe blow to the head (note that this one is always considered an emergency)

Signs that you might have a ruptured eardrum include:

• Intense ear pain that suddenly gets better
• Ear-ringing (tinnitus)
• Hearing loss
• Ear drainage (clear, bloody, or whitish-yellow)

You may need to be checked for an active infection that requires an oral antibiotic. If no active infection is identified, your doctor may prescribe antibiotic ear drops to help prevent an infection from occurring.

If after a few weeks your eardrum has not healed, you will need to discuss other methods to repair your eardrum with your doctor, preferably an ear, nose, and throat specialist (ENT). A tympanoplasty (medical repair of the eardrum in a doctor's office) may be necessary. The doctor may also want to try a 1 percent topical sodium hyaluronate solution, which has been shown to help in the healing of ruptured eardrums.

Ear drainage that is clear or slightly blood-tinged can be caused by skin problems in the ear, such as eczema or swimmer's ear. In this case, the ear drainage is the result of a weeping wound and should resolve within a few days.

In rare instances, clear ear drainage can be the result of a cerebral spinal fluid (CSF) leak. Leaks most commonly occur due to traumatic injuries or surgeries or as a result of chronic ear disease, including chronic middle ear infections or cancer.

Large amounts of clear drainage may actually be cerebral spinal fluid and can indicate damage to the skull, brain, or spine. Do not move someone who is on the ground after sustaining a head or neck injury; instead, call emergency medical services. Any traumatic injury should have emergency medical attention.

Bright red ear drainage is generally the result of a serious condition and should be seen by a doctor.

Bloody ear drainage can be the result of a foreign object in the ear, which is fairly common in children, or a head injury.

There are also certain medical conditions, such as cancer, that may cause bloody ear drainage. People who are on blood-thinning medications, such as aspirin or Coumadin (warfarin), may be more likely to have bloody ear drainage.

Aside from ear wax, blood, and clear ear drainage, you may also experience white, yellow, or foul-smelling drainage. These types of ear drainage need to be assessed by a doctor as they may be signs of an active infection. If the drainage is a result of a bacterial infection, antibiotics will be required.

If you suspect that the ear drainage is not the result of an ear emergency, you may want to solve the problem on your own, but you need to avoid the following:

• Do not try to blindly clean out your ear with cotton swabs or any other object.
• Do not wash out or place any medicine in your ear until you have seen a doctor.
• Do not try to shove gauze or other items into your ear to prevent the drainage.

You may feel like you should "wait it out" to see if the drainage clears on its own, but in some cases, a doctor is your best option. Such cases include:

• Severe pain that won't subside
• A persistently high fever
• A significant amount of bright red blood coming from the ear
• Drainage after a significant blow to the head
• Sudden hearing loss
• A sharp object that has caused bloody drainage

Over-the-counter acetaminophen can be used to control pain and fever.

Seeing fluid draining from your ear can be frightening. Most cases will not be an emergency. However, in many cases, it will be useful in following up with your doctor to ensure proper treatment. Fortunately, aside from traumatic injury, side effects like tinnitus or hearing loss will not be permanent and will improve with time and proper treatment.