Ear infections are one of the most common consultations in primary care. They affect children and adults, and almost everyone has had one at some point.
Most heal without consequences. But some, poorly treated or recurrent, can leave permanent hearing loss.
In this article we explain the three types of otitis, their symptoms, when to see a specialist and why the hearing care professional is a key piece in early detection.
The ear in three parts
To understand infections, you first need to understand where they occur. The ear has three areas:
- Outer ear: the pinna and the ear canal up to the eardrum.
- Middle ear: the cavity behind the eardrum, with the three ossicles. It connects to the throat through the Eustachian tube.
- Inner ear: the cochlea (hearing) and the vestibular system (balance).
Each area has its own type of otitis, with different causes and risks.
Types of ear infections
Otitis externa
It is inflammation of the outer ear canal. It is known as “swimmer’s ear” because moisture encourages it.
- Causes: water trapped in the canal, use of cotton swabs, small injuries, eczema. The most common germs are bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus. Sometimes the cause is a fungus.
- Symptoms: intense pain when touching or moving the ear, itching, discharge and a feeling of fullness.
- Usual treatment: cleaning of the canal by a professional and medicated ear drops prescribed by a doctor.
Otitis media
It is the infection or inflammation of the middle ear. It is very common in children because their Eustachian tube is shorter and more horizontal.
There are three main forms:
- Acute otitis media: usually appears after a cold. It causes ear pain, fever and sometimes discharge if the eardrum perforates.
- Otitis media with effusion: there is fluid behind the eardrum, but no active infection. Often painless. The main symptom is hearing loss.
- Chronic otitis media: there is a perforated eardrum or discharge that repeats for months. It can damage the ossicles.
Otitis interna (labyrinthitis)
It is inflammation of the inner ear. It is less common but more serious. It is usually caused by a virus.
- Symptoms: severe vertigo, nausea, sudden hearing loss and tinnitus.
- Treatment: requires urgent medical assessment. Treatment depends on the cause.
Comparison table
| Type | Affected area | Main symptoms | Hearing risk |
|---|---|---|---|
| Otitis externa | Ear canal | Pain when touching the ear, itching, discharge | Low, temporary |
| Acute otitis media | Behind eardrum | Pain, fever, blocked ear | Temporary, unless complications |
| Otitis media with effusion | Behind eardrum | Hearing loss without pain | Temporary; affects language in children if persistent |
| Chronic otitis media | Eardrum and ossicles | Repeated discharge, hearing loss | Can be permanent |
| Otitis interna | Cochlea and vestibule | Vertigo, sudden hearing loss, tinnitus | Can be permanent |
When to see a specialist
See a doctor or an ENT specialist if any of these occur:
- Ear pain lasting more than 48-72 hours.
- High fever along with ear pain.
- Discharge from the ear.
- Swelling or redness behind the ear.
- Ear infections that recur several times a year.
Go to the emergency room if there is sudden hearing loss, severe vertigo or facial paralysis. Sudden hearing loss is an emergency: treatment is most effective in the first hours.
Relationship with hearing loss
Temporary hearing loss
Otitis externa and otitis media produce conductive hearing loss. Sound does not reach the inner ear properly because there is inflammation, discharge or fluid in the way.
This loss usually disappears when the infection resolves. In otitis media with effusion it can last weeks or months.
In children, persistent otitis media with effusion can delay language development. That is why it is important to check hearing after recurrent episodes.
Permanent hearing loss
In some cases the damage does not recover:
- Chronic otitis media: can erode the ossicles or leave a perforated eardrum.
- Cholesteatoma: an abnormal skin growth in the middle ear. It destroys structures and requires surgery.
- Labyrinthitis: can damage the cochlea and cause permanent sensorineural hearing loss.
Prevention and care
- Do not use cotton swabs inside the ear canal. They push wax in and can cause injuries.
- Dry your ears well after swimming or showering. Tilt your head and dry only the outside.
- Use custom earplugs if you swim frequently or are prone to otitis externa.
- Treat colds and allergies properly. Nasal congestion encourages otitis media.
- Avoid tobacco smoke, especially around children.
- Keep vaccinations up to date, especially pneumococcal and flu vaccines.
If you use hearing aids
- Clean the hearing aid, domes and molds daily. We explain how in Hearing Aid Cleaning Protocol #1.
- Remove the hearing aid if you notice pain, discharge or inflammation in the canal, and consult your hearing care professional.
- Change domes as often as recommended. An old dome accumulates dirt and moisture.
- Consider a vented mold if you tend to have moisture issues. We explain in Custom Hearing Aid Molds vs Universal Domes.
The hearing care professional’s role in early detection
The hearing care professional does not diagnose or treat infections. However, they are in a privileged position to detect them early.
A hearing aid user visits the clinic regularly. At each check-up, the professional can:
- Perform an otoscopy and detect inflammation, discharge, wax plugs or perforations.
- Perform a tympanometry to identify fluid in the middle ear.
- Compare audiograms and detect sudden changes in thresholds.
- Refer to an ENT specialist when alarm signs are detected.
- Record episodes of otitis in the medical history to track recurrence.
Good anamnesis makes the difference. If you record previous otitis, ear surgeries and current symptoms, you can better fit the hearing aid and detect complications earlier.
Frequently asked questions
Are ear infections contagious? Otitis itself is not contagious. However, the cold viruses that cause it are.
Can I use my hearing aids if I have an ear infection? If you have otitis externa or discharge, it is best to stop using them until the doctor says otherwise. Always consult your hearing care professional.
Can you lose your hearing from an ear infection? In most cases, no. The loss is temporary. The risk increases with chronic or recurrent infections, or those that affect the inner ear.
What foods help recovery? A balanced diet supports the immune system. You can find ideas in 10 Foods That Protect Your Hearing (and 5 That Harm It).
Keep track of every patient
Detecting an ear infection early depends on having all the patient’s information at hand: previous episodes, otoscopies, audiograms and referrals.
Audyum centralises the anamnesis, check-ups and history of each patient so you never miss a warning sign.