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Health condition · Clinically reviewed

Ear discharge, what it means and how UK ENT teams sort it out.

Most ear discharge is a treatable infection. Some patterns, foul-smelling, bloody or persistently watery, point to something that needs a specialist.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, ENT UK and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK otology practice including microsuction, topical therapy and cholesteatoma surgery.

Key facts

Otorrhoea at a glance.

The essentials, in plain English, what it is, what it can point to, and how UK ENT teams sort it out.

  • What it is

    Otorrhoea is fluid coming from the external ear canal. It is a symptom of an underlying ear problem, not a diagnosis in itself.

  • Character matters

    Purulent, serous, bloody, foul-smelling or watery discharge each points to a different cause and pathway.

  • Common causes

    Otitis externa and acute otitis media with a perforation account for most cases in primary care.

  • Serious causes

    Cholesteatoma, necrotising otitis externa, CSF otorrhoea and malignancy are uncommon but need specialist ENT input.

  • Assessment

    History, otoscopy, microsuction, swabs, tuning fork tests and audiometry, with CT or MRI where indicated.

  • Treatment

    Aural toilet plus targeted topical therapy for most infections; surgery for cholesteatoma and selected structural causes.

Why this guide matters

The character of the discharge tells the story.

Purulent, watery, bloody or foul-smelling, each pattern points to a different cause. The three points below shape the rest of this guide.

  • Most cases are treatable infections

    Otitis externa and acute otitis media with a perforation cover the majority of cases and respond well to aural toilet and topical drops.

  • Some patterns need imaging

    Foul-smelling, persistent, painful or blood-stained discharge deserves ENT review with CT, and sometimes MRI, of the temporal bone.

  • Cholesteatoma is a surgical disease

    A discharging ear with a bad smell and hearing loss should be assumed to be cholesteatoma until proven otherwise. Surgery is definitive.

How the diagnosis is made

From first drop to a clear plan.

The steps a UK GP or ENT team will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Onset, duration, character, odour, swimming, trauma, prior ear surgery, hearing loss, vertigo and facial-nerve symptoms.

  2. 02

    Assessing

    External and otoscopy

    Look at the pinna and canal, then examine the tympanic membrane for perforation, retraction or crust.

  3. 03

    Assessing

    Microsuction (specialist ENT)

    Suction clears discharge and debris so the eardrum can actually be seen and topical therapy can reach it.

  4. 04

    Confirming

    Tuning forks and facial nerve

    Rinne and Weber help separate conductive from sensorineural loss. A facial-nerve check is essential.

  5. 05

    Confirming

    Swab and audiometry

    Culture and sensitivity, including fungal, when discharge is chronic or resistant. Pure-tone audiometry and tympanometry quantify the loss.

  6. 06

    Deciding

    CT temporal bone

    For cholesteatoma, necrotising otitis externa, suspected malignancy and trauma. Maps bone erosion before surgery.

  7. 07

    Deciding

    MRI and beta-2 transferrin

    MRI for soft-tissue and intracranial extension. Beta-2 transferrin confirms a CSF leak when otorrhoea is clear and watery.

Typical timeline: first review to a settled plan in days for most infections, longer when surgery is involved.

Patterns

What ear discharge can look like.

The character, colour and smell of otorrhoea, alongside associated symptoms, guide the differential and the need for referral.

  • Purulent discharge

    Yellow or green pus points to bacterial otitis externa, acute otitis media with a perforation, or chronic suppurative otitis media.

  • Serous or watery discharge

    Clear fluid can be inflammatory, but a persistent clear leak after trauma or surgery raises the possibility of a CSF leak.

  • Bloody discharge

    Blood-stained fluid suggests trauma, a granular ear or, less commonly, a neoplasm of the canal or middle ear.

  • Foul-smelling discharge

    A persistent bad odour is the classic hallmark of cholesteatoma and necrotising otitis externa.

  • Hearing loss

    A conductive loss alongside discharge points to a middle-ear problem: perforation, ossicular disruption or cholesteatoma.

  • Facial weakness or vertigo

    Facial-nerve weakness, severe vertigo or intense pain suggest deeper spread and need urgent ENT assessment.

  • Recurrent or chronic discharge

    Discharge lasting more than six weeks, or repeatedly returning, warrants specialist review to rule out CSOM or cholesteatoma.

  • Red flag - out-of-proportion pain

    Severe pain in an older person with diabetes or immunosuppression suggests necrotising otitis externa - an ENT emergency.

Treatment

How ear discharge is treated in the UK.

Aural toilet plus targeted topical therapy for most infections, systemic antibiotics for spreading disease, and surgery for cholesteatoma and selected structural causes.

  • Aural toilet and microsuction

    The cornerstone of otitis externa and CSOM care. Clearing debris lets topical drops work and often relieves symptoms quickly.

  • Topical antibiotic drops

    Ciprofloxacin, Otomize, Sofradex or Locorten-Vioform, targeted to the likely organism. A wick may be used when the canal is very swollen.

  • Acetic acid and antifungals

    Acetic acid drops acidify the canal. Clotrimazole is added when fungal otitis externa is confirmed on swab or microscopy.

  • Systemic antibiotics

    Reserved for spreading infection, systemic upset, or necrotising otitis externa where intravenous ciprofloxacin is used with microbiology input.

  • Grommet care

    A short course of antibiotic drops usually settles discharge from a grommet. Persistent leak needs specialist ENT review.

  • Cholesteatoma surgery

    Tympanomastoid surgery, canal-wall-up or canal-wall-down, sometimes endoscopic, is the definitive treatment for cholesteatoma.

  • CSF leak repair

    Many CSF otorrhoeas settle with conservative care. Persistent leaks are repaired by neurosurgery and skull-base rhinology working together.

  • Head and neck oncology

    When malignancy is confirmed, care moves to a specialist head and neck MDT for combined surgery, radiotherapy and reconstruction planning.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT specialist knows your ears and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Otitis externa and otitis media.

  • ENT UK. Guidance on cholesteatoma and chronic suppurative otitis media.

  • BMJ Best Practice. Assessment of otorrhoea.

  • British Society of Otology. Standards for microsuction and aural care.

Red flags

When ear discharge needs urgent attention.

Most cases are managed in primary care or a routine ENT clinic. These are the situations that are not, and where a specialist opinion is needed quickly.

  • Necrotising otitis externa

    Severe pain out of proportion to signs in a person with diabetes or immunosuppression. Skull-base osteomyelitis is a life-threatening ENT emergency.

  • Facial-nerve weakness

    New facial weakness alongside ear discharge suggests deep spread from cholesteatoma, malignancy or severe infection. Refer the same day.

  • Suspected CSF leak

    Clear watery discharge after head trauma or ear surgery needs urgent assessment. Beta-2 transferrin confirms CSF and guides repair.

  • Foul-smelling chronic discharge

    A persistent bad-smelling ear should prompt a specialist ENT opinion to exclude cholesteatoma.

  • Persistent bloody discharge

    Blood-stained otorrhoea, especially when painless and unilateral, needs specialist review to exclude neoplasia.

  • Severe vertigo or meningism

    Vertigo, headache, fever or neck stiffness alongside otorrhoea can signal labyrinthitis or intracranial extension.

  • Discharge in a young child

    A persistently discharging ear in a child, or a suspected foreign body, needs ENT assessment rather than repeated antibiotic courses.

  • Post-operative deterioration

    Increasing pain, discharge or facial weakness after mastoid or middle-ear surgery deserves prompt review by the operating team.

  • Immunocompromise and diabetes

    Lower the threshold for imaging and specialist referral. These groups are prone to necrotising infection and unusual organisms.

Living with it

Small habits, calmer ears.

Four things that make the biggest day-to-day difference: keeping the ear dry, using drops properly, leaving cotton buds alone, and escalating early when things do not settle.

A quiet reminder

Chronic discharge deserves a proper look.

An ear that keeps leaking is telling you something. Microsuction in an ENT clinic will often reveal the cause quickly.

  1. 01 Dry ears

    Keep the ear dry

    While the canal is inflamed or a perforation is present, avoid getting water in the ear. Cotton wool with petroleum jelly works well for showers.

  2. 02 Drops

    Use drops correctly

    Warm the bottle in your hand, lie on your side, drop, then stay put for a couple of minutes so the fluid reaches the eardrum.

  3. 03 No cotton

    Leave cotton buds out

    Cotton buds push wax and debris deeper, damage the skin and worsen otitis externa. Wipe only what you can see on the outer ear.

  4. 04 Escalate

    Ask for help early

    Discharge that lasts beyond a couple of weeks, smells bad, or comes with hearing loss or facial weakness is a reason to see ENT.

Frequently asked

Everything we get asked about ear discharge.

Quick answers on causes, red flags, tests and treatment.

  • What is otorrhoea?

    Otorrhoea is any fluid coming from the external ear canal. It is a symptom, not a diagnosis, and can be purulent, serous, bloody, foul-smelling or watery depending on the underlying cause.

  • Is a discharging ear always an infection?

    No. Bacterial and fungal infections of the canal or middle ear are the most common causes, but discharge can also come from cholesteatoma, trauma, a CSF leak, granulomatous disease or, rarely, a tumour.

  • When should I worry about a foul smell from my ear?

    A persistent bad-smelling ear, especially with hearing loss, is a classic feature of cholesteatoma. It should be assessed by an ENT specialist rather than treated with repeated courses of drops.

  • What is necrotising otitis externa?

    It is a severe, spreading infection of the ear canal and skull base, mostly in older people with diabetes or immunosuppression. Severe pain, granulation tissue in the canal and cranial-nerve palsies are red flags that need urgent ENT care.

  • How is a CSF leak from the ear diagnosed?

    A clear watery discharge after trauma, ear surgery or spontaneously should raise the question. A sample can be tested for beta-2 transferrin, which is specific to cerebrospinal fluid, alongside CT and MRI imaging.

  • Can I fly or swim while my ear is discharging?

    Swimming is usually not advised until the discharge has settled and any perforation has healed. Flying is generally safe, but discuss it with your clinician if you have pain, active infection or recent ear surgery.

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