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  • Writer's pictureDr. Koralla Raja Meghanadh

Ear infections: types, causes, symptoms, and prevention tips

Updated: Feb 13


Ear infections can be caused by bacteria and fungi typically. Rarely can viruses be responsible.


Otitis is the technical term used for ear infections. Otitis is a word derived from Latin and means inflammation in the ear.


Ear infections can be classified broadly based on the location of the infection. An ear can be divided into three parts: the outer ear canal, the middle ear, and the inner ear.


The most common ear infection is the bacterial middle ear infection, known as otitis media. In fact, it is one of the most commonly occurring infections in the body.


Ear infections: types, causes, symptoms, and prevention tips

Neglecting an ear infection can lead to its spread within the ear, potentially causing permanent hearing loss. That's why detecting and treating the infection early on is crucial to avoid any further complications. In this article, we will briefly describe every ear infection so that you are well aware of the possible types of ear infection and their causes.


Types of ear infections

Ear infections can be divided into three parts:


Middle ear infections

Otitis media, also known as a middle ear infection, is a type of infection that usually occurs as a result of the middle ear's connection to the nose through a tube called the eustachian tube. This tube connects the middle ear to the back of the nose, known as the nasopharynx. Its primary function is to circulate air and maintain air pressure in the middle ear.


In many cases, when we contract an infection that affects the nasopharynx, mucus can travel from the nasopharynx to the middle ear through the eustachian tube. This can lead to the accumulation of fluids or blockage of the tube if the fluid becomes thick, resulting in negative pressure in the middle ear. This negative pressure can cause fluids from the blood to leak into the middle ear. Otitis media is one of the most common types of infections that can occur in the human body. If the infection progresses, it can spread to other ear parts.


Types

  1. Acute Suppurative Otitis Media or Acute Otitis Media

  2. Serous Otitis Media

  3. Otitis Media with Effusion

  4. Acute suppurative otitis media

  5. Chronic Suppurative Otitis Media or Cholesteatoma


Causes

Middle ear infections, or otitis media, are secondary infections caused by infections that affect the back of the nose (nasopharynx), like the common cold and sinusitis. The middle ear is connected to a eustachian tube that ends in the back of the nose. The middle ear gets air supplied through this tube. So, when there is any blockage in this tube, the fluids will get collected in the middle ear leading to a middle ear infection. The fluid can even stagnate when there is negative pressure in the ear. The ear has the capacity to absorb the air, and it requires a constant supply of air as it constantly absorbs the air. But when the ear or eustachian tube is blocked, there will be no air supply into the middle ear leading to negative pressure. When there is negative pressure, the fluids seep into the middle ear from the skin lining. Because of these, the fluids will stagnate, and create a conducive environment for bacteria to grow, resulting in middle ear infections or otitis media.


Here we have a list of conditions that can cause middle ear infections.

  1. The untreated common cold is a frequent cause of middle ear infections since it's one of the most common infections in the human body.

  2. Blowing your nose forcefully, especially when one nostril is blocked, can create high pressure in the back of your nose (nasopharynx) and push fluids into the middle ear.

  3. Smoking, whether actively or being exposed to secondhand smoke, can cause inflammation in the lining of the nose. This inflammation can travel back into the eustachian tube and lead to a blockage, resulting in a middle ear infection.

  4. Chronic sinusitis can cause fluids from the sinuses to seep into the nasopharynx, which can then enter the middle ear and cause an infection. Click here to know more.

  5. Allergies that affect the lining of the nose, throat, breathing pathway, lungs, voice box, nasopharynx, and eustachian tube can create a blockage in the eustachian tube, potentially triggering a middle ear infection.

  6. Extra growths or tumors in the nasopharynx can block the opening of the eustachian tube, creating negative pressure in the middle ear and leading to otitis media (middle ear infection).

  7. Adenoids, which are extra growths in the back of the nose, are a common cause of middle ear infections in children. They can block the opening of the auditory tube, causing a middle ear infection.

  8. Sudden changes in air pressure, such as rapidly ascending to high altitudes, using high-speed elevators in tall buildings, diving into water, or traveling by airplane, can cause a mismatch in air pressure between the middle ear and the atmosphere. This can trigger a middle ear infection, especially if the eustachian tube is partially blocked due to allergies or other mentioned causes.

  9. Feeding habits in babies can cause ear infections as eustachian tubes are more horizontally aligned due to the limited space in babies' head. This positioning makes it easy for milk to travel to the eustachian tube and enter the middle ear. Click here to know more.

Symptoms

Otitis media symptoms are

  1. Severe ear pain

  2. Fever

  3. Ear discharge

  4. Deafness or block sensations

As the middle ear is in between the outer ear and the inner ear, the disease can spread to the adjacent parts showing additional symptoms.


Treatment

As the middle ear infection is secondary, the primary cause needs to be treated for any treatment to be effective. Antibiotics, as per the type of infection, are given as the infection is bacterial.


It's essential to consult an ENT doctor for a proper treatment prescription. Incorrect diagnosis, self-medication, and reliance on home remedies may aggravate the condition, particularly in cases of otomycosis.


Prevention

  1. Always treat the common cold by using nasal drops, steam inhalations can prevent the infection from spreading to middle ear.

  2. Don’t blow your nose when you have common cold especially one nostril is blocked.

  3. Treating chronic sinusitis

  4. Avoid smoking

  5. Take anti-allergic medication when you have allergies. They will not only bring down the mucus secretions in your nose but can decrease the inflammation in the mucosa lining that ends up fully or partially blocking the eustachian tube.

  6. Try to gulp your saliva whenever you experience sudden pressure changes.


Outer ear infections - Otitis externa

The outer ear, or the external ear, is the external part of the ear that collects the sound signals and directs them to the middle ear through the ear drum.

As the outer ear is connected to the external environment, any infection from the outside can affect the outer ear. These ear infections are called Otitis Externa.


This is the second most common type of ear infection.

Outer ear infections, Otitis externa, are often caused by bacteria or fungi or viruses or other substances.


So, we can divide Otitis Externa into several types based on the cause of ear infection.

  1. Bacterial Otitis Externa

  2. Otomycosis

  3. Myringitis bullosa hemorrhagica

  4. Swimmer’s Ear

The bacterial type of outer ear infection is common in non-humid areas, whereas Otomycosis, the fungal type, is common in humid areas.

Myringitis bullosa hemorrhagica is a rare type.

Swimmer’s ear is common in swimmers, as the name indicates.


Causes of outer ear infection

Our outer ear is constantly exposed to the environment, making it susceptible to infections caused by various bacteria, fungi, and viruses. The risk of infection increases when we use objects like cotton buds to clean our ears.

Normally, bacteria and fungus live in our ears, controlling each other without causing any issues.

When we insert external objects into our ears, it can cause the skin to rupture, creating an opportunity for bacteria or fungi to attack.

The likelihood of infection also rises when we attempt to clean our ears when they are wet. Wet skin is delicate and more prone to rupture, which can lead to a condition called otitis externa. Otitis externa can be either bacterial or fungal in nature.


Bacterial Otitis Externa

It can start as a pimple or a boil in the outer ear. Bacteria like Staphylococcus aureus can cause it. If the infection occurs in diffusely, i.e., at a more extensive area, it is called diffuse otitis externa. This is caused by Pseudomonas aeruginosa.


Bacterial Otitis Externa, also known as a bacterial infection of the outer ear canal, can occur as a secondary infection due to otitis media, which is primarily caused by bacteria. Otitis media leads to the accumulation of fluids in the middle ear, causing pressure on the eardrum. In some cases, this pressure can result in the rupture or perforation of the eardrum, allowing the infected fluids to seep into the outer ear. This typically occurs when a middle ear infection is left untreated.


Otomycosis

Fungal ear infections in the outer ear canal are called Otomycosis and are mainly caused by Aspergillus Niger and sometimes by Candida.

Otomycosis is mostly caused due to human interventions with outer ear-like

  1. Cleaning ears, especially after a bath, this activity can rupture the ear skin exposing the skin to fungus. The wax in the ear can act as food for the fungus.

  2. Adding oil to ears can act as food for fungus and promote fungus growth in the ear.

  3. The use of antibiotic ear drops without a prescription can also cause fungal ear infections in the outer ear canal by disturbing the balance between fungi and bacteria that coexist in our ears. Adding antibiotic ear drops to the ear in the absence of bacterial infection in the outer ear canal can kill the existing bacteria that balance the fungi in our ear and make it convenient for the fungus to prosper in our ear.


Myringitis bullosa haemorrhagica

A rare type of ear infection caused by a virus. This affects the outer ear canal.


Swimmer’s ear

Swimmer's ear is a type of otitis externa that can be bacterial, fungal, or both. It is an inflammation of the ear canal caused by exposure to chlorinated or toxic water. It can result from both harmful chemicals and chlorine used in swimming pools. This condition commonly affects swimmers due to their frequent water exposure.


Symptoms

Symptoms that can be shown by otitis externa.

  1. Itchy ears are typical indicators of Otomycosis.

  2. Pain in the ear

  3. Ear discharge, indicating perforation of the ear drum

  4. Hearing loss due to perforation of the ear drum


Treatment

We at home will not be able to diagnose the ear infection correctly. So, it is always better to see an ENT doctor who will diagnose correctly and identify if it is fungal or bacterial and prescribe you medicines accordingly.


Prevention

  • Avoid using external objects to clean ears, especially after bath.

  • Don’t put oil into ear, as it can promote fungus growth.

  • Don’t use antibiotic ear drops or any other ear drops without a prescription.

  • Avoid home remedies and always consult a doctor for any issue with ear.

  • Always use proper protection for ears while swimming


Inner ear infections

The inner ear, the innermost part of the hearing system, plays a crucial role in hearing and maintaining the balance of our body. Inner ear infections are always secondary infections, usually spread from adjacent structures. Two common types of inner ear infections are vestibulitis and labyrinthitis.


This infection, if neglected, can spread to the brain.


Types

Vestibulitis

Vestibulitis is a disease in the inner ear that affects the vestibular part of the labyrinth. The labyrinth is responsible for maintaining the balance of the body. So, when the infection spreads to this part, causing vestibulitis following symptoms can be observed.

  1. Nausea

  2. Vomiting

  3. Giddiness, loss of balance in the body


Labyrinthitis

In labyrinthitis, hearing and balance are affected as the entire labyrinth is involved, unlike vestibulitis. So the symptoms can be listed as

  1. Nausea

  2. Vomiting

  3. Giddiness, loss of balance in the body

  4. Severe Hearing loss

  5. Tinnitus

Causes

Inner ear infections can occur under two circumstances:

  1. Middle Ear Infections Spreading: The most common cause of inner ear infections is when infections originating in the middle ear spread to the inner ear. This is a typical route for ear infections to reach the inner ear.

  2. Infections from the Brain Spreading: Inner ear infections can also be caused by infections spreading from the brain. Meningitis and Encephalitis are conditions that can lead to an inner ear infection. However, it's important to note that this cause is quite rare.

Symptoms

As the inner ear has two functions hearing and maintaining balance. Both these functions will be affected, causing.

  1. Loss of hearing

  2. Blockage of ears or clogged sensation

  3. Tinnitus

  4. Giddiness, loss of balance

  5. Vomiting

Treatment

The treatment for an inner ear infection typically involves a combination of antibiotics given at a higher dosage than usual, followed by the administration of steroids. Once the infection reaches the inner ear, the treatment approach becomes more aggressive due to the rapid progression of the disease.

In response to the infection, our body acts defensively by forming a protective bone around the inner ear. This condition is called labyrinthitis ossificans. This serves as a barrier to prevent the infection from spreading to the brain or nearby structures. However, if this bone formation process is completed, it can result in permanent damage to that side of the ear. Unfortunately, there is no known method to reverse this condition.

If the bone formation process begins, immediate cochlear implant surgery becomes the only option to halt its progress and preserve hearing function. This surgical intervention can help prevent further damage and provide a means of hearing assistance.

Prevention

Treating ear infections on time can prevent the spread of the disease to the inner ear. In fact, it is very crucial once the infection reaches inner ear.


Who are at risk of developing an ear infection?

Ear infections can impact people across all age groups. However, specific factors can heighten the likelihood of developing such infections. Here are several prevalent risk factors to consider:

  1. An individual who gets repeated cold attacks is at risk of developing an ear infection.

  2. An individual who cleans their ear, especially after the bath, is at risk of developing an ear infection.

  3. Swimmers who clear their ears after the swim.

  4. An individual with adenoids is always at high risk.

  5. Any disease in the nasopharynx and nose will increase the risk of middle ear infection.

  6. Wrong feeding habits can increase the risk of developing ear infections in babies.


It's important to remember that while these factors may increase the risk of ear infections, they don't guarantee that an individual will develop an infection. Proper immunity, maintaining a healthy lifestyle, and seeking prompt medical attention for respiratory infections can help reduce the risk of ear infections.


Symptoms that will help you identify an ear infection

Ear infections can manifest with various symptoms, which can differ based on the type of infection and the specific area of the ear affected. Here are some typical symptoms that are often associated with ear infections:

  • Ear pain

  • Tinnitus

  • Ear block sensation or deafness

  • Pus from ear

  • Itching in the ear

  • Foul smelled watery discharge from the ear

  • Giddiness, loss of balance

  • Vomiting


To know more about these symptoms, please check out our article "Symptoms of an ear infection." This article will help you understand ear infection symptoms according to their types and help you identify your ear infection.


Complications

While most ear infections resolve without any complications, in some cases, complications can arise. Here are some potential complications associated with ear infections:

  1. The infection can spread to the ear bones or temporal bone causing complications like abscesses and swelling in the back of the ear.

  2. It can create complications in the adjacent structures or neck.

  3. The ear infection can spread to the brain, causing meningitis and encephalitis.

  4. If the infection spreads to the facial nerve, it will create complications like paralysis of the face, which can restrict eye closure.

  5. If the infection spreads to the tongue's nerves, we can't speak and swallow properly.

  6. If it spreads to the nerves of the throat, it will create complications like swallowing the food, which goes into the lungs instead of the food pipe.


How to prevent an ear infection?

Here are some prevention tips for preventing ear infections:

  1. Avoid using objects like cotton buds, pins, keys, etc., to clean or scratch your ear.

  2. Treat sinusitis and common cold properly on time.

  3. Don't blow your nose when you have the common cold.

  4. When you have a common cold taking steam inhalations can reduce the risk of developing ear infections.

  5. Plug your ears while swimming to avoid chlorinated and toxic water.

  6. Avoid cleaning your ears after swimming.


Following these prevention tips can reduce the risk of ear infections and their complications and promote your overall ear health. It's important to remember that individual susceptibility to ear infections can vary, and some factors may be beyond your control. So, if you or your child experience persistent ear infections, consult an ENT doctor for further evaluation and guidance.


An article by


FAQs

What is the most common ear infection?

The most common ear infection is otitis media, a bacterial infection in the middle ear. In fact, it is among the most common conditions that can occur in the human body. Its a secondary infection and can be triggered due to multiple causes.


Can ear infections damage the brain?   

Yes, untreated ear infections can lead to complications such as meningitis and encephalitis, which may damage the brain. Nevertheless, such complications are rare, and most ear infections can be resolved with proper care.


What is the first line antibiotic for ear infections?   

The choice of first-line antibiotics for ear infections varies based on the type of infection and individual factors. Doctors typically determine it after diagnosing the specific situation.


What diseases can occur in the ear?

Various diseases and conditions can impact the ears, affecting hearing and balance. Some common ear diseases include otitis media, otitis interna, outer ear infections, otomycosis, circumscribed otitis externa, swimmer's ear, bullous myringitis, cholesteatoma, otosclerosis and otospongiosis.

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