Otalgia is pain in the ear.  Otorrhea is drainage from the ear.  Both are often associated with infection somewhere in the ear.  Other causes of pain include eustacian tube dysfunction, trauma, foreign bodies or temporomandibular joint syndrome.  Other causes of drainage include allergy or water entering a perforation or tube in the eardrum.

Infection can occur in any part of the ear.  If the ear canal becomes infected, this is called otitis externa.  When water becomes trapped in the ear canal after bathing or swimming, the canal may become infected.  This is commonly known as “swimmer’s ear”.  Typically, the canal is swollen, very tender, and may drain white to yellow liquid.  This infection responds well to ear drops and keeping water out of the ear.

In some cases, the ear canal may drain chronically, it may itch severely or it may have persistent flaking or skin breakdown.  This condition is called chronic otitis externa or eczema of the ear canal.  The most common cause of ear canal eczema is allergy, usually to foods or yeast.  If the condition does not respond to ear drops, then skin testing and treatment of food or yeast allergies is recommended.

Pain in the ear is often a sign of middle ear infection, also known as otitis media.  It is frequently accompanied by hearing loss or balance problems.  Acute otitis media is generally treated with antibiotics and decongestants.  When chronic otitis media develops, myringotomy tubes may be required to relieve infection, persistent fluid, pain, hearing loss or balance disorder.  If untreated, chronic otitis media can lead to retractions or perforations of the eardrum.  At this point, more serious infections can occur, leading to persistent drainage, further hearing loss or vertigo, and possibly cholesteatoma.  The latter refers to skin trapped in the middle ear or mastoid and can result in severe complications.

Often ear pain is the result of eustacian tube dysfunction, which in turn is a result of colds or allergies.  This conditionally usually responds to decongestants, antihistamines, or steroids but may require myringotomy tubes and/or allergy testing.  Temporomandibular joint syndrome may also cause ear pain.  It is initially treated with soft diet, warm packs, and anti-inflammatory medications.  Dental consult should be sought if conservative management fails.

Ear drainage may occur from a pre-existing myringotomy tube or perforation of the eardrum.  This may be a result of water entering the ear, or could be from a cold or allergy.  Keeping the ear dry and using ear drops will usually stop the drainage.