Ear infections explained: causes, symptoms, and treatment options

Ear infections, medically referred to as otitis, are common conditions that can affect people of all ages, though they are especially prevalent in children. These infections occur when bacteria or viruses enter the ear, leading to inflammation and often following a cold, flu, or respiratory illness.

A renowned ENT specialist looks at the different types of ear infections, how they present themselves, and the available treatment options to help you better recognise and manage this condition.

Which parts of the ear can get infected?

Ear infections are categorised based on which part of the ear is affected. The ear is divided into three main sections: the outer ear, middle ear, and inner ear.

Outer ear infection: Known as otitis externa, this type is often called “swimmer’s ear” because it commonly affects those who swim frequently. It occurs when moisture is trapped in the ear canal, creating an ideal environment for bacterial growth. Symptoms may include pain, redness, itching, and occasionally a foul-smelling discharge.

Middle ear infection: The most common type, otitis media, affects the area directly behind the eardrum. It frequently develops after a cold or respiratory infection. When the Eustachian tubes, which connect the middle ear to the back of the throat, become blocked, fluid can accumulate and lead to bacterial growth. Symptoms often include ear pain, a sensation of fullness, hearing difficulty, and fever.

Inner ear infection: Though less common, inner ear infections affect the deepest part of the ear and are known as labyrinthitis. They can cause dizziness (vertigo), hearing loss, and balance difficulties. Unlike outer and middle ear infections, these infections are usually caused by viruses rather than bacteria.

What are the typical symptoms of an ear infection?

Symptoms of ear infections can differ based on the type of infection and how severe it is. That said, some common symptoms to watch for include:

• Ear pain or discomfort.
• Hearing difficulties.
• Fluid drainage, which may be clear, yellow, or bloody.
• Dizziness or balance issues.
• Fever (particularly common in middle ear infections).
• A sensation of pressure or fullness in the ear.

In children, additional signs to watch for include increased irritability, frequent ear-pulling, and difficulty sleeping.

How do doctors diagnose ear infections?

To diagnose an ear infection, an  ENT specialist will usually examine the ear with an otoscope, a small device equipped with a light, to look for signs of infection or fluid buildup. Sometimes, a tympanometry test, which measures the movement of the eardrum, is used to determine if fluid is trapped in the middle ear. If the provider suspects inner ear involvement, additional tests may be performed to assess balance and hearing.

What treatments are recommended for ear infections?

The chosen treatment depends on the type and severity of the infection. Many mild infections, especially in the outer and middle ear, resolve on their own. However, treatments may include:

Pain relief: Over-the-counter medications such as paracetamol or ibuprofen can help reduce pain and fever.

Antibiotics: Bacterial infections, particularly in the middle ear, may require antibiotics. It’s important to take the entire course as prescribed to avoid recurrence or complications.

Ear drops: For outer ear infections, antibiotic or antifungal ear drops are often effective.

Home remedies: Applying a warm compress to the affected ear and staying hydrated may offer additional relief.

For persistent or severe cases, a specialist may recommend draining fluid from the ear or inserting small tubes to promote drainage, particularly in cases of recurrent middle ear infections.