H66.1-3
DESCRIPTION
A purulent discharge from the ear with perforation for > 2 weeks. If the eardrum has been ruptured for ≥ 2 weeks, a secondary infection with multiple organisms usually occurs. Oral antibiotic treatment is generally ineffective.
TB may present with a chronically discharging ear. Consider the diagnosis of TB if other clinical features suggestive of TB are present (e.g. cough, weight loss, failure to thrive, etc.). See: Pulmonary tuberculosis (TB).
GENERAL MEASURES
- Do not send pus swabs collected from the external ear canal for routine bacterial and fungal MC+S (microscopy, culture and sensitivity) or for microscopy and culture for tuberculosis.
- Explain to patients and caregivers that a chronically draining ear can only heal if it is dry.
- Dry mopping is the most important part of the treatment. It should be demonstrated to the child’s caregiver or patient if old enough. Roll a piece of clean absorbent cloth into a wick.
- Carefully insert the wick into the ear with twisting action.
- Remove the wick and replace with a clean dry wick.
- Repeat this until the wick is dry when removed.
- Do not leave anything in the ear.
- Do not instil anything else in the ear.
- Avoid getting the inside of the ear wet while swimming and bathing.
- Check HIV status if unknown.
REFERRAL
- All sick children, vomiting, drowsy, etc.
- Painful swelling behind the ear.
- Ear discharge still present for ≥ 4 weeks, despite dry mopping.
Note: These referrals do not all require referral to an ENT. They may be referred to a hospital outpatient department for consideration of a topical antibiotic eardrops.
- Any attic perforation.
- Any perforation not progressively improving after 3 months or closed by 6 months, even if dry.
- Moderate or severe hearing loss.