Otitis (Ear Infections)

Otitis (o-TIE-tis) is an inflammation of the internal or external parts of the ear, usually caused by infection.


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Ear infections

Eustachian tube

Otitis externa

Otitis media


Swimmers ear

Ears have three main parts: outer, middle, and inner. The eardrum is between the outer and middle ear and is the part of the ear that responds to sound waves by vibrating. The pea-size middle ear normally is filled with air, and when the eardrum vibrates, the tiny bones of the middle ear are set into motion to send sound signals to the inner ear, which is filled with fluid. The eustachian (yoo-STAY-she-un) tube connects the middle ear with the throat and nose, normally allowing air and fluid to move in and out of the middle ear.

When parts of the ear become infected, an earache may occur. There are two basic types of ear infection: otitis media and otitis externa.

Otitis Media

Middle ear infections

If a person has a cold or allergies, the eustachian tube may not function properly and fluid can become trapped in the middle ear, which can lead to infection if bacteria or viruses get in. In acute * otitis media, the middle ear becomes inflamed and fills with fluid or pus * .

Chronic * otitis media results if the infection does not go away (with or without treatment) within a few weeks. In more severe or long-lasting cases of chronic otitis media, the eardrum may become permanently damaged or the infection may spread to surrounding structures. More often in chronic otitis media, the infection may be gone but fluid remains and the eardrum cannot move freely to transmit sound waves. This condition is known as chronic otitis media with effusion * and can cause a temporary hearing loss in the affected ear. Recurrent otitis media occurs when a person has repeated ear infections but gets better between infections.

Otitis media is not contagious, but common colds and other infections of the respiratory tract * that can lead to it are. When people cough, sneeze, laugh, or talk, they can spread the viruses or bacteria that cause colds and respiratory illnesses to their hands, to the surfaces around them, and into the air. Other people can breathe in these germs or touch contaminated surfaces with their hands and spread the germs to their noses and mouths. If the conditions are right, the germs enter the middle ear through the eustachian tube or cause a blockage in the eustachian tube, setting the stage for an ear infection to develop.

* acute describes an infection or other illness that comes on suddenly and usually does not last very long.

* pus is a thick, creamy fluid, usually yellow or greenish in color, that forms at the site of an infection. Pus contains infection-fighting white cells and other substances.

* chronic (KRAH-nik) means continuing for a long period of time.

* effusion (ih-FYOO-zhun) is an excessive accumulation of body fluid in a body space or cavity, such as the middle ear.

* respiratory tract includes the nose, mouth, throat, and lungs. It is the pathway through which air and gases are transported down into the lungs and back out of the body.

Adults can get otitis media, but it is more common in children, especially those under age 3. The eustachian tubes of children are narrower, shorter, and more horizontal than those in adults, making it easier for germs to enter and fluid to build up. Young children also have frequent respiratory infections, which are often accompanied by ear infections in children this age.

Signs and symptoms

Signs and symptoms of otitis media include:

  • in babies, irritability, fussiness, or tugging on the ear
  • ear pain or a feeling of pressure
  • buzzing or ringing sounds in the ear
  • pus draining or bleeding from the ear (if the eardrum has ruptured)
  • mild hearing loss
  • fever
  • vomiting or diarrhea (dye-uh-REE-uh)

Complications of otitis media include a ruptured ear drum due to high-pressure fluid buildup in the middle ear, mastoiditis * , and, rarely, spread of infection to the brain. Hearing loss also can occur; it is typically temporary, except in long-standing chronic disease.

Otitis Externa

Swimmer's ear

Otitis externa, often called swimmer's ear, is an inflammation or infection of the outer ear canal. It is not contagious but occurs when bacteria or fungi enter through a break in the skin inside the ear.

Otitis externa often occurs after swimming or diving, when moisture can break down the protective wax and skin in the ear canal. Although it is called swimmer's ear, it can occur whenever these barriers are broken down in other ways, such as by frequent cleaning with cotton swabs or scratching inside the ear too roughly. Once the skin is broken, bacteria or fungi can enter and cause an infection. The ear will become red, swollen, and painful to the touch.

Otitis externa is fairly common and affects mostly teens and young adults. People who spend a long time swimming or diving are most susceptible.

Occasionally otitis externa can have complications. In about 1 percent of cases, the infection persists and results in chronic otitis externa. Rarely, this can lead to malignant otitis externa, a serious condition in which the infection spreads to the bones and nerves of the ear, skull, and brain; this occurs almost exclusively among people with diabetes * . Cellulitis * is another possible complication.

Three by Three

A third of all children experience three or more ear infections by the time they turn 3 years old. Otitis media is the number-one diagnosis among children for sick visits to the doctor, and it is the leading cause of hearing loss in children.

Source: American Academy of Otolaryngology

* mastoiditis (mas-toy-DYE-tis) is an infection of the mastoid bone, located behind the ear.

* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough insulin or the body cannot use the insulin it makes effectively, resulting in increased levels of sugar in the blood, This can lead to increased urination, dehydration, weight loss, weakness, and a number of other symptoms and complications related to chemical imbalances within the body.

* cellulitis (sel-yoo-LYE-tis) is an infection of the skin and the tissues beneath it.

Signs and symptoms

Signs and symptoms of otitis externa include:

  • ear pain that usually worsens if the ear is touched or pulled
  • red, swollen outer ear canal
  • green or yellow pus draining from the ear
  • mild loss of hearing

How Are Ear Infections Diagnosed?

A doctor will examine a person's ears, inside and out, checking for redness, swelling, and abnormal collections of fluid. The doctor will take a close look at the eardrum by using a lighted instrument called an otoscope (O-toh-skope). An audiogram may be performed to test the person's hearing and a tympanogram (tim-PAH-no-gram) may be done to check for normal vibration of the eardrum and pressure levels in the middle ear.

Samples of fluid, pus, and blood from inside the ear may be tested to discover whether a bacterium, virus, or fungus is causing the infection. If the doctor thinks the infection has spread to surrounding bone or cartilage, an X ray or computerized tomography * (CT) scan of the head may be performed.

How Do Doctors Treat Ear Infections?

Over-the-counter, non-aspirin painkillers such as acetaminophen (uh-see-teh-MIH-noh-fen) and warm heating pads can be used to ease the throbbing pain of earaches. Antibiotic eardrops are used to treat otitis externa. Oral (by mouth) antibiotics are used to treat otitis media and may be prescribed in more severe cases of otitis externa. However, antibiotics are not always necessary to treat otitis media because the condition is not always caused by bacteria. Many cases of otitis media are caused by viruses, which do not respond to antibiotic treatment, but it is often difficult to tell the difference. Even if bacteria are the cause of an ear infection, many cases will get better on their own, although antibiotic treatment lowers the risk of the infection spreading and clears up symptoms sooner. Typically, the symptoms of acute otitis media improve within the first 2 to 3 days of antibiotic treatment. Chronic infections, however, can last several weeks or months. In children with chronic otitis media, it may be helpful to surgically insert a small plastic tube in the eardrum that allows air to flow into the middle ear and prevent fluid buildup that can interfere with hearing.

In cases of external otitis, doctors recommend that water be kept out of the ear canal during recovery; earplugs or shower caps can help keep out water while bathing, and swimming should be avoided.

How Can Ear Infections Be Prevented?

Frequent hand washing can help prevent spread of the germs that cause colds and other respiratory illnesses, which often lead to ear infections, especially in young children. Toys should be washed often to keep infections from spreading among babies and young children in daycare settings.

* computerized tomography (kom-PYOO-ter-ized toe-MAH-gruh-fee) or CT, also called computerized axial tomography (CAT), is a technique in which a machine takes many X rays of the body to create a three-dimensional picture.

To prevent fluid from pooling in eustachian tubes, experts recommend that babies be bottle-fed in an upright position and not sleep with a bottle. Breastfeeding also can help prevent otitis media in babies, as can avoiding exposure to cigarette smoke.

Vaccinations * against Streptococcus pneumoniae (strep-tuh-KAH-kus nu-MO-nye), a common cause of otitis media, and influenza * can reduce the likelihood of contracting otitis media. Treating allergies or removing enlarged adenoids * that block the eustachian tubes may decrease the chances of having recurrent or chronic ear infection in some patients.

After swimming or bathing, thoroughly drying ears with a towel can help get rid of water and lower the risk of contracting otitis externa. For avid swimmers, preventive eardrops can be used after swimming. Nothing should be inserted into the ears because of the risk of injuring the skin of the ear canal or damaging the eardrum.

* vaccinations (vak-sih-NAY-shunz). also called immunizations, are the giving of doses of vaccines, which are preparations of killed or weakened germs, or a part of a germ or product it produces, to prevent or lessen the severity of a disease.

* influenza (in-floo-EN-zuh), also known as the flu, is a contagious viral infection that attacks the respiratory tract, including the nose, throat, and lungs.

* adenoids (AH-din-oyds) are the fleshy lumps of tissue behind the nose that contain collections of infection-fighting cells of the immune system.

See also
Common Cold
Streptococcal Infections



American Academy of Otolaryngology—Head and Neck Surgery, 1 Prince Street, Alexandria, VA 22314. This group of doctors who specialize in treating ear, nose, and throat disorders has information about ear infections on their website.
Telephone 703-836-4444


KidsHealth.org . KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children's health. It contains articles on a variety of health topics, including otitis.

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