Otorrhea

Introduction Ear leaks, also known as ear discharges, refer to abnormal fluid accumulation or outflow in the external auditory canal. The fluid can come from the external auditory canal, the tissue surrounding the ear, the middle ear, the labyrinth or the intracranial. Normal human ear canal has a small amount of sebaceous glands, parotid glands secrete some substances and epithelial desquamation, while some people's biochemical components of sputum mutate and secrete yellow oil, which is normal. This situation can be seen in many diseases. The nature, smell and color of the effluent are often a special manifestation of certain diseases. Generally, no special treatment is needed for this condition, as long as the external auditory canal is kept clean, avoid excessive stimulation, and prevent infection.

Cause

The skin of the normal external auditory canal has sebaceous glands, and almost all glands have a catheter opening in the hair follicle cavity. This secretion is rare and generally does not constitute an overflow. Another gland, the parotid gland, often secretes snoring, which prevents foreign bodies from deepening the human ear canal, and generally does not constitute an ear discharge. However, some people secrete more secretions, as if Vaseline accumulates in the external auditory canal and has a special odor, which is mistaken for pus. Often referred to as "oil ear", it is a normal phenomenon. When inflammation, allergic reaction or tumor occurs in the external auditory canal, serous, serous or purulent secretions may occur.

The normal tympanic and mastoid airway system is lined with cubic epithelial mucosa. Except for the glandular and goblet cells near the tympanic cavity and the eustachian tube opening, the rest have no secretory function. Normally only a small amount of mucus and water are secreted. When the middle ear is inflamed, the mucosa of the tympanic cavity and even the entire mastoid airway system has different degrees of epithelial and glandular metaplasia, and a large number of goblet cells appear, and the secretions are greatly increased, and various kinds of ear discharges are formed.

an examination

Related inspection

Otolaryngology CT examination of ear, nose and throat swab bacterial culture

1. Otolaryngology CT examination: CT examination of the ear, nose and throat is a method of examining the ear, nose and throat by CT.

2. Electrical audiometry: It is a method of recording potential changes induced by the auditory system due to sound stimulation using modern electronic technology.

3. Brain evoked potentials: brain function was examined by brain evoked potentials.

4. Acoustic impedance check: A method of checking the ear by special inspection.

5, ear, nose, throat swab bacterial culture: the bacteria in the ear, nose, throat are from the outside, under normal circumstances, not disease. However, infection may occur due to a decrease in body or local body resistance and other external factors. Therefore, bacterial culture of ear, nose and throat swabs can isolate pathogenic bacteria and contribute to the diagnosis of otitis media, rhinitis, sinusitis, diphtheria, suppurative tonsillitis and acute pharyngitis. The specimen is taken by a doctor using a sterile cotton swab and the secretion of the patient's lesion is taken for examination.

Differential diagnosis

External ear disease

(1) External auditory canal

The external auditory canal is red and swollen, with severe pain and obvious tragus tenderness and traction of the ear wheel. After the abscess ruptures, the pure purulent secretions flow out, the amount is not much, and there are countless liquids.

(two) external ear eczema

Auricle, ear canal, posterior sulcus diffuse or localized skin erosion, exudation. The exudate is a pale yellow serous exudate, the amount varies. After the water evaporates, a yellow-brown suede is formed.

(3) diffuse otitis externa

The outer layer of the outer ear is eroded, and the early stage of acute infection is a thin serous secretion that gradually becomes a thick purulent discharge. The tympanic membrane is intact.

(four) external ear canal mycosis

It is easy to develop in a humid environment. In the depth of the external auditory canal, even the surface of the tympanic membrane is covered with a yellow-brown membrane, which can be in a powdery state in a dry state, and has a moist ink-like membrane like a wet skin after it is wet. Remove the membrane and test it. See the epidermis erosion, congestion, and pulp exudation.

(5) Necrotic otitis externa

Often occurs in elderly patients with diabetes. In the case of Pseudomonas aeruginosa infection, the outer ear expands into the middle ear and the mastoid, and severe tissue destruction or even dead bone formation occurs. The pain is severe, the secretions are stinky, the pus is thin, and it is copper-green.

Middle ear disease

(a) bullous tympanitis

For viral infection, there is one or several purple-red bullae on the outer ear canal near the tympanic membrane on the surface of the tympanic membrane. After the ulceration, the plasma exudate flows out.

(two) acute suppurative otitis media

There are symptoms such as earache, headache, and fever. After perforation, bleeding pus is started, followed by mucopurulent secretions, which are more abundant and volatility overflow. When it is near healing, it is partially liquid and the amount is reduced. If the tympanic membrane is perforated, after 2-3 weeks of treatment, the pus suddenly increases, or a large amount of pus suddenly decreases or stops, accompanied by earache. Symptoms such as increased headache and fever should be considered for acute mastoiditis.

(C) chronic suppurative otitis media

1. The simple tympanic membrane has a central perforation, and the secretion is buccal or septic, generally no odor, and if so, disappears after repeated wiping. Most of the pus is intermittent and the amount varies.

2. Osteopathic type refers to the middle ear bone and the auditory bone with bone ulcers, necrosis and granulation or polyps. The secretion is purulent, with less shadow and odor. The mastoid X-ray film has bone destruction.

3. The cholesteatoma tympanic membrane has a slack or a posterior superior marginal perforation, and there is a cheese-like secretion in the perforation, which is small in amount and has a strange smell. The mastoid X-ray film (Xu, Mei's position) is helpful for diagnosis.

(four) middle ear cancer

There is bloody secretion in the external auditory canal. It can be seen that there is granulation tissue in the deep part of the ear canal, which is easy to bleed.

Cerebrospinal fluid otorrhea

1. In the longitudinal fracture of the tibial rock, traumatic cerebrospinal fluid otorrhea may occur.

2. The mastoid surgical instruments are improperly used or the signs are unclear, and the meninges are caused by accidental injury to the meninges.

3. Spontaneous cerebrospinal fluid otorrhea: When the congenital inner ear and middle ear are abnormally developed, the cerebrospinal fluid can communicate with the perilymph from the subarachnoid space through the anatomical abnormal inner ear canal. Once the cerebrospinal fluid pressure is increased, the cerebrospinal fluid rhinorrhea can be formed (the tympanic membrane is not perforated). Time) or ear leak (when the tympanic membrane has perforations). The mastoid X-ray film is helpful for diagnosis.

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