In otorrhoea (otorrhoea) “runs” the ear. The emerging secretion can serous, bloody-serous or purulent his ears flow may be associated with symptoms such as ear pain, fever, itching, dizziness, tinnitus and hearing loss. Etiology The causes arise in the ear canal, middle ear or cranial cavity. Certain causes tend due to the severity of their symptoms or diseases associated with acute curves. Others show a slower, chronic course usually, but manifest themselves occasionally acute (see Table: Causes of otorrhoea). In general, the most common causes of acute otitis media with perforation Chronic otitis media (with perforation of the eardrum and / or cholesteatoma) otitis externa most serious causes necrotizing external otitis and a tumor of the ear. Causes of otorrhoea reason suspects findings Diagnostic procedure Acute vaginal discharge * Acute otitis media with perforated TM Severe pain, with relief in the event of purulent discharge Clinical examination Chronic otitis media ear flow in patients with chronic perforation, sometimes with cholesteatoma Can also be used as chronic vaginal discharge manifest Clinical Unters uchung Sometimes, high-resolution CT of the temporal bone CSF leakage caused by head injury Significant clinically obvious head injury or recent surgery liquid varies from crystal clear and pure blood cranial CT including skull base otitis externa (infectious or allergic) Ansteckend: Often after swimming, local trauma;. significant pain, aggravation with traction of the ear often chronic dermatitis of the ear with itching and skin lesions in the history Allergic: Often after using ear drops, more itching, redness, less pain than with the infectious form Typically participation of the earlobe in places where drops Both run from the ear canal: canal very edematous, inflamed, with detritus; normal eardrum Clinical examination post-tympanostomy tube after insertion of a tympanostomy tube can occur on contact with water Clinical examination Chronic outflow tumor discharge often confused in the ear canal bloody, mild pain occasionally visible lesion in the ear canal light with otitis externa in the early stages biopsy computed tomography ( CT) MRI in some cases cholesteatoma Tympanic membrane in the history Scaly debris in the ear canal, eardrum bag, filled with cheesy debris Sometimes polypoid lesion or granulation tissue over the cholesteatoma computed tomography (CT) Culture (No use of MRI, except in cases of suspected intracranial extension) Chronic suppurative otitis media long history of ear infections or other diseases of the ears macerated Less pain than with external otitis ear canal, ear drum granulation immobile, deformed, usually visible perforation Physical examination usually Culture debris Usually in children Ill-smelling, purulent discharge debris often visible when examined, except for significant edema or discharge Clinical examination mastoiditis Often fever, untreated or not healed otitis media in the history of redness, tenderness over the mastoid Clinical examination culture Usually CT necrotizing otitis externa usually known immunodeficiency or diabetes Chronic pain Periaurikuläre swelling and tenderness, granulation tissue in the ear canal Occasionally facial palsy CT or MRI K ulture granulomatosis with polyangiitis (formerly Wegener’s granulomatosis) Often with respiratory symptoms, chronic rhinorrhea, arthralgia and ulcers urinalysis chest x-ray test for anti-neutrophil cytoplasmic antibodies biopsy * <6 weeks. TM = eardrum. Rating History The history of the disease process should cover the duration of symptoms and whether the symptoms are recurrent. Important Accompanying symptoms include pain, itching, decreased hearing, dizziness and tinnitus. Patients will be asked about activities that can affect the ear canal or the eardrum (z. B. swimming, insertion of objects incl. Swab, use of ear drops). Head trauma sufficient to cause a cerebrospinal fluid leakage can be seen easily. In reviewing the organ systems should (z. B. nasal discharge, cough, joint pain), by symptoms of failures of the cranial nerves and after systemic symptoms that suggest a granulomatosis with polyangiitis. The history should all known diseases of the ears, ear surgery (especially the insertion of a ventilation tube) and diabetes or immunodeficiency festhalten.Körperliche investigation The investigation will begin with a review of vital signs for fever. The ear and surrounding tissues (especially the region above the mastoid) are inspected for erythema and edema. At the pinna is pulled, and the tragus is pressed gently to see if the pain gets worse. The ear canal is examined using an otoscope; the character of the effluent and the presence of lesions in the auditory canal granulation tissue or foreign bodies are noted. Edema and discharge, the view with the exception of the distal ear canal severely restrict (a rinse should not be used in the event that an eardrum is present), but if possible the eardrum to inflammation, perforation, deformation and signs of cholesteatoma (z should. B. detritus are examined in the ear canal polyp eardrum). When the ear canal is swollen at the meatus (z. B. like in severe otitis externa) or abundant outflow is, the careful aspiration may allow a sufficient investigation and at the same time a treatment (for. Example, the application of drops, with or without insert). The cranial nerves are tested. The nasal mucosa is checked for elevated, granular lesions and the skin on vasculitic lesions. Both can a granulomatosis with polyangiitis hindeuten.Warnhinweise The following findings are particularly important: short-ago larger head trauma dysfunction of the cranial nerves (including sensorineural hearing loss.) Fever erythema at the ear or at periaurikulären tissue diabetes or immunodeficiency interpretation of the findings eardrum tears, otitis externa, debris or other uncomplicated reasons for otorrhoea usually can be determined by otoscopic examination. Some findings have strongly indicative value (see Table: Causes of otorrhoea). Other findings are less specific, but indicate a more serious problem that involves more than just a disease of outer ear or middle ear, dizziness and tinnitus (disorder of the inner ear) cranial nerve deficits (disorder that affects the base of the skull) erythema and tenderness of the ear and are / or surrounding tissue (significant infection) Testing Many cases after clinical evaluation clear. When a cerebrospinal fluid leakage is eligible, the liquid may be analyzed for ?2-transferrin or ?-trace protein; these substances occur in a cerebrospinal fluid leak, but not for other types of effluent. If the investigation reveals no clear indication of the etiology, patients should get an audiogram, a CT of the temporal bone or a gadolinium MRI. A biopsy should be considered if granulation tissue is present in the ear canal. The therapy treatment depends on the particular cause. On suspicion of cerebrospinal fluid leakage, most doctors wait until the final diagnosis before they begin antibiotic therapy so that meningitis is not veiled. Key points An acute vaginal discharge in a patient without chronic ear problems or immune deficiency is probably due to otitis externa or perforated otitis media back. may require a heavy external otitis an idea the specialist for extensive cleaning and possible placement of a deposit. Patients (diagnosed or undiagnosed) with recurrent ear symptoms, findings on the cranial nerves or systemic symptoms should be referred to a specialist.