Does suppurative otitis media cause ear drainage?

Does Suppurative Otitis Media Cause Ear Drainage?

Yes, suppurative otitis media definitively causes ear drainage—this is the hallmark clinical feature that distinguishes it from non-suppurative forms of otitis media. 1, 2

Understanding the Terminology

The term "suppurative" literally means pus-forming, and this distinguishes it from "nonsuppurative" otitis media (also called otitis media with effusion or OME), which involves sterile fluid without active infection. 3, 4

Key Distinctions:

• Chronic Suppurative Otitis Media (CSOM): Characterized by persistent purulent drainage from the middle ear through a perforated tympanic membrane 1, 2
• Acute Otitis Media (AOM): Can present with otorrhea (ear drainage) when the tympanic membrane ruptures due to pressure from infected middle ear fluid 1
• Otitis Media with Effusion (OME): Specifically defined as fluid in the middle ear without signs of acute infection and without drainage, as the tympanic membrane remains intact 3, 4

Clinical Presentation of Drainage in Suppurative Otitis Media

Chronic Suppurative Otitis Media (CSOM):

• Persistent purulent drainage is the defining feature, occurring through a perforated tympanic membrane 1, 2
• The drainage is typically purulent and malodorous 5
• CSOM represents a serious bacterial infection that can follow untreated acute otitis media 6
• This condition is a leading cause of hearing loss in developing countries 1

Acute Otitis Media with Perforation:

• Otorrhea occurs when pressure from middle ear infection causes tympanic membrane rupture 1
• The drainage represents infected middle ear effusion escaping through the perforation 7
• Tympanic membranes that fail to heal after AOM can develop chronic infection, leading to CSOM 7

Diagnostic Implications

The presence or absence of ear drainage is a critical diagnostic feature that helps clinicians distinguish between different types of otitis media:

• Drainage present = Suppurative otitis media (either acute with perforation or chronic) 1, 2, 5
• No drainage, fluid behind intact membrane = Otitis media with effusion (nonsuppurative) 3, 4
• No drainage, bulging intact membrane = Acute otitis media without perforation 1

Common Pitfall to Avoid

Do not confuse OME (nonsuppurative otitis media) with suppurative forms. OME involves middle ear fluid but lacks acute infectious symptoms, fever, ear pain, and drainage because the tympanic membrane remains intact. 3, 4 This distinction is crucial because OME does not require antibiotics, while suppurative otitis media does. 4, 6

Treatment Considerations for Drainage

When suppurative otitis media with drainage is present:

• Aural toilet combined with topical antibiotics is the most effective treatment approach 6
• Topical quinolones (such as ofloxacin) are more effective than non-quinolones for resolving otorrhea 6, 8
• Topical treatment is more effective than systemic antibiotics alone 6
• The most common bacterial pathogens causing CSOM with drainage are Staphylococcus aureus (44.9%) and Pseudomonas aeruginosa (16.9%) 9