Otorrhea--a fresh look at an old symptom

• Published in: JAAPA (Montvale, N.J.) Vol. 19; no. 8; pp. 30 - 37
• Main Author: Scott, Pamela Moyers
• Format: Journal Article
• Language: English
• Published: United States 01.08.2006
• Subjects: Anti-Infective Agents - therapeutic use; Antibiotics; Bacteria; Clinical outcomes; Defense mechanisms; E coli; Ear diseases; Ear Diseases - diagnosis; Ear Diseases - drug therapy; Ear Diseases - etiology; Exudates and Transudates; Fungal infections; Health technology assessment; Humans; Infections; Middle Ear Ventilation - adverse effects; Otitis Externa - diagnosis; Otitis Externa - drug therapy; Otitis Externa - etiology; Otitis Media with Effusion - diagnosis; Otitis Media with Effusion - drug therapy; Otitis Media with Effusion - etiology; Pathogens; Patients; Pharmaceutical Solutions - therapeutic use; Physical examinations; Staphylococcus infections
• ISSN: 1547-1896; 0893-7400
• DOI: 10.1097/01720610-200608000-00006

Bacterial infections are generally associated with a white to cream-colored discharge that is moderate in amount and consistency, although it can be discolored and purulent.3With fungal infections, the discharge is typically fluffy, more abundant, and white to off-white in color, although it can also be cream, black, gray, or aqua.3 The microspores on the hyphae are often visible during the otoscopic examination. Ointments should never be used.7 A recent meta-analysis failed to reveal any randomized clinical trials comparing treatment outcomes in subjects given oral antibiotics versus either placebo or otic antibiotic drops.8 Systemic antibiotics should be considered only if the patient is younger than 2 years, exhibits early signs of complications, appears toxic, is immunocompromised (including having diabetes), or is unresponsive to topical treatment.3-5 Despite the recommendations not to use antibiotic drops alone in patients younger than 2 years, fluoroquinolones (with or without an added corticosteroid) are approved by the FDA for use in some of these conditions, starting at 6 or 12 months of age.13-15 Corticosteroids The decision to add a topical corticosteroid preparation to the treatment regimen must be individualized.