Neck Discharging Sinus: Chronic Infection or Underlying Disease?
A neck discharging sinus is an abnormal opening in the skin of the neck that repeatedly leaks pus, fluid, or blood-stained discharge. Unlike a simple wound, a sinus usually indicates an ongoing underlying disease and should never be ignored.
In adults, a persistent neck sinus may result from chronic infection, tuberculosis, infected congenital cysts, or head and neck cancer. From an ENT and Head & Neck specialist’s perspective, this symptom requires prompt and thorough evaluation.
What Does a Neck Discharging Sinus Look Like?
Patients commonly notice:
- A small opening or pit on the neck skin
- Recurrent discharge or staining of clothes
- Intermittent healing and reopening
- Surrounding skin redness or thickening
- Minimal pain or tenderness
- Long duration, sometimes months
Temporary improvement does not mean resolution.
Common Causes of Neck Discharging Sinus
1. Tuberculous Lymphadenitis
A common cause in endemic regions, often painless with chronic discharge.
2. Infected Branchial Cleft Cyst
Congenital cysts may rupture and form a sinus in adulthood.
3. Chronic Bacterial Infection
Persistent deep-seated infection draining to the skin.
4. Post-Surgical or Traumatic Sinus
May follow incomplete healing.
5. Head & Neck Malignancy
Cancer may ulcerate and discharge, especially if infected.
🚨 Red Flags You Must Not Ignore
Seek urgent ENT assessment if:
- Discharge persists >2 weeks
- Recurrent discharge despite antibiotics
- Blood-stained or foul-smelling fluid
- Associated neck lump
- Weight loss or fever
- History of TB exposure, smoking, or alcohol use
A chronic neck sinus in adults is abnormal until proven otherwise.
How an ENT Specialist Evaluates a Neck Discharging Sinus
ENT evaluation is systematic:
- Detailed history and duration
- Full head & neck examination
- Assessment of sinus opening and tract
- Flexible nasoendoscopy
- Ultrasound or CT scan of the neck
- Microbiological tests
- FNAC or biopsy when indicated
This ensures correct diagnosis before definitive treatment.
Treatment Depends on the Cause
✅ Infection or TB
- Targeted antibiotics or anti-TB therapy
✅ Congenital Sinus
- Surgical excision after infection control
✅ Malignancy
- Urgent referral to head & neck cancer team
- Multidisciplinary oncological care
Treating the opening alone is never sufficient.
When Should You See an ENT Specialist in Kuala Lumpur?
Consult an ENT specialist if:
- A neck wound keeps discharging
- The problem keeps recurring
- There are associated red-flag symptoms
Early ENT assessment prevents serious complications and delayed cancer diagnosis.
👨⚕️ ENT Specialist’s Perspective
A neck discharging sinus is a sign, not a diagnosis. From a head and neck standpoint, it often represents chronic disease beneath the surface. ENT evaluation aims to identify and treat the root cause, not just close the skin opening.
Reviewed by Dr Ameen, ENT Specialist, Kuala Lumpur
Dr. Ameen, ENT Specialist in Kuala Lumpur 