Ear Infection (Otitis)

An ear infection, or otitis, is inflammation of part of the ear. Otitis externa affects the skin of the ear canal and is often called swimmer's ear. Otitis media affects the space behind the eardrum and is very common in young children. A third form, chronic otitis media, means a long-standing perforation or discharging ear.

Most acute infections settle within a few days, many without antibiotics. Recurrent or persistent middle ear problems can reduce hearing and in children may affect speech, which is when ENT treatment such as ventilation tubes or eardrum repair is considered.

Symptoms

• Ear pain, often worse lying down in middle ear infection
• Pain when the outer ear is pulled or pressed, typical of canal infection
• Itching and discharge from the ear canal
• Muffled hearing or a feeling of fullness
• Fever, irritability and ear pulling in small children
• Sudden relief of pain followed by discharge, when the eardrum gives way
• Persistent painless smelly discharge in chronic disease

Causes and risk factors

Otitis media usually follows a cold: the Eustachian tube between the nose and the ear swells shut, fluid collects, and viruses or bacteria such as pneumococcus and Haemophilus multiply. Children are prone because their tubes are short and horizontal and their adenoids are large. Nursery attendance, passive smoking and dummy use raise the risk. Otitis externa follows water exposure, cotton buds, hearing aids or earplugs, eczema or psoriasis of the canal, and is caused by Pseudomonas, staphylococci or fungi. Chronic disease may involve cholesteatoma, a skin cyst that erodes bone.

How it is diagnosed

• Otoscopy: Examination of the canal and eardrum with a lighted instrument, or a microscope in the ENT clinic, distinguishes canal from middle ear infection.
• Tympanometry: A brief pressure test that shows whether fluid is present behind the eardrum.
• Hearing test: Audiometry measures any hearing loss, especially with persistent fluid or chronic discharge.
• Ear swab: Taken from a discharging ear that has not responded to first treatment, to check for resistant bacteria or fungus.
• CT scan of the temporal bone: Used in chronic discharging ears to look for cholesteatoma and to plan surgery.

Treatment options

• Pain relief and observation: Paracetamol or ibuprofen for 2 to 3 days is the first step for most middle ear infections in otherwise well children and adults.
• Antibiotics by mouth: For severe or prolonged middle ear infection, children under two with both ears affected, or a discharging ear.
• Ear drops and microsuction: The treatment for otitis externa: the canal is cleaned under a microscope and antibiotic and steroid drops are used for about a week. The ear is kept dry.
• Ventilation tubes (grommets): Tiny tubes placed in the eardrum for repeated infections or persistent fluid with hearing loss. Often combined with adenoid removal in children.
• Tympanoplasty and mastoid surgery: Repair of a perforated eardrum, and removal of cholesteatoma or chronic infection from the mastoid bone.

When it is urgent

Seek emergency care locally for swelling, redness or tenderness behind the ear that pushes the ear forward, severe headache with neck stiffness or drowsiness, weakness of one side of the face, spinning vertigo with vomiting, high fever in a baby under 3 months, or severe ear pain in someone with diabetes or a weakened immune system that is not settling.

Travelling to Türkiye for treatment

Acute ear infections should be treated at home, and flying with one is painful and can rupture the eardrum. Travel is reasonable for planned surgery: grommets, tympanoplasty or mastoid surgery, with a hearing test and CT beforehand. Allow about a week after eardrum or mastoid surgery and ask the surgeon when flying is safe, as pressure changes can disturb a fresh graft.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

الأسئلة المتكررة