Treating a child with a draining ear is a common occurrence in the pediatric primary office. The symptoms of otorrhea are broad, and a multitude of factors must be considered in arriving at a diagnosis. The assessment begins with a thorough history of the frequency, duration, and characteristics of the drainage. Physical examination of the affected ear requires cleansing of the external auditory canal before the tympanic membrane can be accurately assessed. The ear must be adequately visualized for accurate diagnosis and treatment. Differential diagnoses include acute suppurative otitis media, otitis externa, granuloma, and bullous myringitis. The acutely draining ear is frequently an uncomplicated suppurative event that will respond well to a regimen of aural hygiene and topical therapy. Patients with a chronically draining ear should be referred to an otolaryngologist for further diagnostics and aggressive therapy. Children with tympanostomy tubes are especially at high risk for suppurative complications. Avoiding the introduction of water into the ear, protecting the ear from water, and prophylactic topical treatment are options that have been suggested for prevention of otorrhea.