Otitis: Symptoms, Causes & Treatment

Dr. Flávio Sakae
Clinical review: Dr. Flávio Sakae ENT Specialist CRM 100700-SP
Created by: Jillian Kinton-Vieira Registered Nurse
Key points
  • Otitis can affect the outer, middle, or inner ear and may cause pain, pressure, fever, drainage, dizziness, or hearing changes.
  • Outer ear infections are often linked to trapped water, while middle ear infections are common in children after colds.
  • Treatment depends on the cause and may include pain relievers, antibiotics or antifungals, or procedures in more severe cases.

Otitis is an infection or inflammation of the ear that can involve the ear canal, the middle ear, or the inner ear. It can cause symptoms such as ear pain, itching, a feeling of fullness or pressure, fever, or pus-like drainage from the ear.

Otitis is usually classified based on the part of the ear that is affected: outer ear (otitis externa), middle ear (otitis media), or inner ear (otitis interna). It can be triggered by using cotton swabs or putting small objects in the ear, getting water trapped in the ear, or infections caused by viruses, bacteria, or fungi.

Treatment for otitis is usually managed by a primary care provider and depends on the cause. In some cases, you may be referred to an ENT (ear, nose, and throat) specialist.

An otolaryngologist examining the ear of a woman with otitis.

Ear infection symptoms

The main symptoms of an ear infection (otitis) can include:

  • Ear pain

  • Fever

  • Itching in the ear

  • Redness or swelling of the ear

  • Fluid or pus in the ear

  • Dizziness

  • Reduced hearing

  • A feeling of pressure in the ear

  • Ringing in the ear

Babies and children with ear infections may also rub or scratch their ears, cry a lot for no obvious reason (especially at night), seem more irritable than usual, or have trouble sleeping.

In more severe cases, an ear infection can also lead to mood changes, facial paralysis, labyrinthitis, or other nervous system problems.

See a healthcare provider as soon as symptoms start so they can determine the cause and type of ear infection and recommend the best treatment. This is usually a primary care provider or a pediatrician.

Confirming a diagnosis

Otitis is diagnosed by a primary care provider, pediatrician, or ENT specialist based on symptoms, including when they started and how severe they are, medical history, and a physical exam. During the exam, the clinician uses a lighted device called an otoscope to look inside the ear canal and at the eardrum.

The provider may also order additional tests to identify the type of otitis, such as blood tests, a CT scan, or an MRI.

In some cases, the provider may collect a sample of the ear discharge so it can be analyzed at the lab in order to identify the microorganism causing the infection.

Possible causes

The main causes of otitis are:

  • Infections caused by viruses, such as respiratory syncytial virus (RSV), influenza (flu), rhinovirus, or adenovirus

  • Bacterial or fungal infections

  • Cochlear implant

  • Allergies

  • Reflux

  • Water entering the ear

  • Insertion of small objects into the ear or use of cotton swabs

  • Anatomical changes in the structures of the ear

In addition, bottle feeding in babies and children may allow milk to flow back toward the middle ear, which can increase the risk of infection.

Main types

The main types of otitis are:

1. Otitis externa (outer ear infection)

Otitis externa can occur in adults or children and affects the outer part of the ear up to the eardrum, which is the membrane that separates the outer ear from the middle ear and is important for hearing.

This type of otitis is usually linked to moisture and heat, which are common after swimming, and, according to the CDC, trapped water in the outer ear canal can create a moist environment that helps bacteria grow.

2. Otitis media (middle ear infection)

Otitis media affects the area behind the eardrum and is common in children. It is often associated with colds or other upper respiratory infections because, according to the American Academy of Pediatrics, a blocked eustachian tube can allow fluid to build up in the middle ear and promote infection.

3. Otitis interna (inner ear infection)

Inner ear otitis, also known as labyrinthitis, affects the deepest part of the ear, where the labyrinth is located, a structure responsible for balance and hearing.

This type of inflammation is usually caused by viruses or bacteria and may lead to symptoms such as dizziness, ear pain, balance problems, ringing in the ear, or hearing loss.

4. Bacterial otitis

Bacterial otitis is caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, for example.

This type of bacterial infection can affect either the middle ear or the outer ear canal and may lead to otitis media or otitis externa, causing inflammation and related symptoms.

5. Eczematous otitis externa (ear eczema) 

Eczema is a chronic inflammatory skin condition that affects the outer ear and ear canal and may lead to otitis externa.

This type of otitis causes intense itching in the ear, skin flaking, and ear pain.

6. Serous otitis

Serous otitis occurs because of a buildup of serous or mucus-like fluid behind the eardrum and mainly affects children.

This type of otitis, also called otitis media with effusion, causes symptoms such as a feeling of pressure in the ear or popping sounds, ear pain, or reduced hearing.

7. Fungal otitis

Fungal otitis is caused by fungi such as Candida albicans or Aspergillus niger and mainly affects the outer ear.

This type of otitis, also called otomycosis, causes intense itching in the ear, a blocked-ear sensation, or discharge from the ear.

Treatment options

Treatment for otitis should be guided by a primary care provider, pediatrician, or ENT and varies based on the location, symptoms, and cause.

The main treatments for otitis are:

1. Medications

A provider may recommend medications to relieve symptoms such as ear pain, discomfort, or fever. Depending on the type of otitis, treatment may include acetaminophen or ibuprofen, antihistamines, or decongestants.

If the otitis is caused by bacteria or fungi, the provider may prescribe antibiotics or antifungals.

In more severe cases of otitis, treatment may require hospitalization so antibiotics can be given directly into the vein.

2. Ear irrigation

In some cases of external otitis, the provider may also clean the ear in the office using warm water with saline or alcohol-based solutions, applied carefully with cotton or gauze.

3. Tympanocentesis

Tympanocentesis is a type of treatment for otitis media performed by an ENT using a thin needle and a 3 mL syringe to drain fluid from the middle ear.

This treatment is done in the doctor’s office using local anesthesia.

4. Surgery

In more severe cases of otitis media, a doctor may recommend surgery, such as a myringotomy. In this procedure, the doctor makes a small opening in the eardrum to drain fluid from the middle ear and place a tiny ventilation tube.

Another surgery is mastoidectomy, which is recommended for chronic otitis media or interna and is performed by an ENT to clean the mastoid bone and remove the infection.

5. Home remedies

Some simple home measures may also help support treatment and relieve symptoms of otitis media, such as drinking plenty of fluids (about 2 liters a day), eating a balanced diet, and applying a warm compress to the outer ear.

Update History
We regularly update our content with the latest scientific information to maintain an exceptional level of quality.

References
  • Centers for Disease Control and Prevention. Preventing swimmer's ear. CDC. Updated 13 Jun 2024. Accessed 17 Apr 2026 https://www.cdc.gov/healthy-swimming/prevention/preventing-swimmers-ear.html
  • Centers for Disease Control and Prevention. Swimming and ear infections. CDC Stacks. 2020. Accessed 17 Apr 2026 https://stacks.cdc.gov/view/cdc/90295
  • American Academy of Pediatrics. Ear infections in children: information for parents. HealthyChildren.org. Accessed 17 Apr 2026 https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Ear-Infection-Information.aspx
  • American Academy of Pediatrics. Ear infection symptoms. HealthyChildren.org. Accessed 17 Apr 2026 https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Ear-Infection-Symptoms.aspx
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