Pus in the ear is a symptom that may be caused by conditions like swimmer's ear (external otitis), middle ear infection, ruptured eardrum, hearing aid use, or frequent exposure to cold water, as seen in surfer's ear.
Depending on the underlying cause, pus in the ear may be accompanied by other symptoms such as severe ear pain, itching, fever, and hearing loss.
A thorough evaluation by an otolaryngologist is recommended to determine the cause and appropriate treatment. Treatment may involve the use of pain relievers, antibiotics, anti-inflammatory medications, ear drainage, or surgery.
What causes pus in the ear?
Pus in the ear can be caused by:
1. External otitis
External otitis is an inflammation of the outer part of the ear. It can cause symptoms like foul-smelling pus in the ear, itching, flaking in the ear canal, ear pain, and reduced hearing.
What to do: Treatment should be prescribed by an ENT specialist, pediatrician, or general practitioner. It often includes ear drops to clean the ear canal, such as saline or alcohol-based solutions. Oral medications like pain relievers, anti-inflammatory drugs, corticosteroids, or antibiotics may also be prescribed.
2. Middle ear infection (otitis media)
Middle ear infections involve inflammation in the inner part of the ear, causing symptoms like pus in the ear, ear pain, fever, and irritability. Headaches and mental confusion can also occur in some cases.
This condition may be triggered by viral or bacterial infections in the upper airways, such as a cold or sinus infection, or due to trauma or allergies.
What to do: The doctor may prescribe medications like ibuprofen, acetaminophen, or dipyrone to reduce inflammation and relieve pain. If the infection is bacterial, antibiotics such as amoxicillin, amoxicillin-clavulanate, or clarithromycin may be indicated.
3. Hearing aid use
Using a hearing aid can disrupt the natural balance of bacteria and fungi in the ear canal, increasing the risk of external ear infections. Poor hygiene or moisture buildup in the ear may lead to symptoms like pus, itching, and ear pain.
What to do: It is important to take care when using hearing aids, such as removing them before showering, exercising, or sleeping. The device should be cleaned regularly using cleaning sprays or wipes specifically made for hearing aids.
4. Foreign objects
Small objects like toys, buttons, insects, or food can become lodged in the ear, especially in children. This can cause inflammation, pain, itching, and pus in the ear.
What to do: Treatment involves removal of the object by an ENT specialist using tweezers or suction. In more severe cases, surgery may be necessary. Objects should never be removed at home, as this can worsen the problem.
5. Myringitis
Myringitis is inflammation of the eardrum, the membrane that separates the outer and middle ear. It can cause symptoms such as ear pressure or mild pain, fever, hearing loss, and pus-filled blisters in the ear.
What to do: Treatment usually involves antibiotics and pain relievers prescribed by a doctor. In cases of bullous myringitis, the doctor may drain the blister with a scalpel to relieve intense pain.
6. Mastoiditis
Mastoiditis is inflammation of the mastoid bone, which is part of the temporal bone located behind the ear. This condition can lead to pus in the ear, pain, redness, warmth, swelling, hearing loss, and tenderness in the area.
What to do: Treatment often involves intravenous antibiotics like ceftriaxone or vancomycin for about two weeks. In severe cases, surgery may be needed to drain the infection or remove the affected bone.
7. Surfer’s ear
Pus in the ear can be a symptom of surfer’s ear, also known as external auditory canal exostosis. This condition is caused by repeated exposure to cold water, leading to the growth of a benign bony lump in the ear canal.
In early stages, surfer’s ear may not cause symptoms. As it progresses, it can lead to recurrent external ear infections, ear discharge, a clogged sensation, hearing loss, and a feeling of water trapped in the ear.
What to do: The doctor may clean the ear canal regularly to remove trapped debris and help prevent complications such as recurrent infections, eardrum rupture, and hearing loss. In cases where bone growth is already present, treatment may require surgery such as canalplasty.
8. Ruptured eardrum
A ruptured eardrum may occur as a complication of an ear infection, barotrauma (pressure changes between the ear and external environment), head trauma, or insertion of objects into the ear.
Symptoms may include pus and/or blood in the ear, hearing loss, itching, severe pain, and ringing in the ear.
What to do: If there is an infection or the eardrum has completely ruptured, the doctor may recommend antibiotic ear drops, such as those containing neomycin and polymyxin B with corticosteroids. In some cases, tympanoplasty—a surgical repair of the eardrum—may be required.
Pus in baby’s ear
Pus in a baby’s ear can occur due to bacterial or viral infections, often linked to throat infections, colds, or other upper respiratory conditions.
In these cases, symptoms may also include irritability, frequent crying, fever, trouble sleeping, balance issues, pulling or rubbing the ear, and reduced response to soft sounds.