Condition	Presentation	Diagnosis	Management
🌊 Otitis Media with Effusion	Clear/serous fluid, ear fullness, reduced hearing, usually painless	Fluid behind TM on otoscopy; tympanometry shows abnormal middle ear pressure	Often self-limiting; persistent → myringotomy with grommet insertion
🔥 Acute Otitis Media with TM Rupture	Severe pain then relief with purulent discharge; fever; common in children	Otoscopy: perforated TM with pus; culture if recurrent	Oral Abx (amoxicillin), topical drops, monitor TM healing
♻️ Chronic Suppurative Otitis Media	Persistent foul-smelling discharge, hearing loss, TM perforation	Otoscopy; CT if cholesteatoma suspected	Topical Abx, regular aural toilet, tympanoplasty/mastoidectomy if severe
🏊 Otitis Externa (Swimmer’s Ear)	Pain on pinna movement, canal swelling, watery/purulent discharge	Otoscopy: inflamed canal; swab if persistent	Topical Abx/steroid drops, aural toilet, avoid swimming until resolved
🤒 Sinusitis (Acute/Chronic)	Thick purulent discharge, facial pressure/pain, congestion, postnasal drip	Clinical; nasal endoscopy or CT if recurrent/chronic	Decongestants, saline irrigation, Abx if bacterial, nasal steroids if chronic
💧 CSF Rhinorrhoea	Clear watery unilateral discharge, worse on bending; Hx trauma/surgery	Glucose test; β-2 transferrin (specific); CT/MRI for localisation	Neurosurgical repair, bed rest, avoid straining, prophylactic Abx
🌸 Allergic Rhinitis	Clear watery discharge, sneezing, itchy nose/eyes, congestion; seasonal/triggered	Clinical; skin prick or IgE testing	Antihistamines, intranasal corticosteroids, allergen avoidance
🍇 Nasal Polyps	Persistent mucoid discharge, obstruction, reduced smell; often with asthma/chronic sinusitis	Nasal endoscopy; CT to assess extent	Intranasal steroids, surgical removal if obstructive/recurrent

💡 Commentary & Clinical Pearls

👂 Ear discharge: Otitis externa is painful on pinna pull; chronic otitis media has a foul smell → suspect cholesteatoma.
👃 Nasal discharge: Colour/quality matters – watery = allergy/CSF leak, purulent = infection.
🚩 Red flags: unilateral persistent discharge, severe pain, systemic illness, facial palsy, or neurological features → urgent ENT/neurosurgical referral.
🧒 Children with recurrent AOM/OME risk speech delay → early ENT referral for hearing assessment and possible grommets.
🧠 CSF leaks must be taken seriously – meningitis risk is high without timely neurosurgical repair.

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Ear and Nasal Discharge

📊 Causes of Ear & Nasal Discharge

💡 Commentary & Clinical Pearls

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