Ear Infections

Tinnitus is a common experience in examples of inner, middle and outer ear infections.

Outer Ear Infection - Causes

Outer ear infections are caused by something irritating the ear canal, such as eczema, water or wearing ear plugs and affects the ear canal (the tube between the outer ear and the eardrum). Swimming is probably the main culprit for causing outer ear infection. The water left inside the ear canal can become a breeding ground for bacteria but aggressive drying of the ears could also be the cause as an infection can also occur if the thin layer of skin that lines the ear canal is injured. Intense scratching, using headphones, hearing aids, or placing cotton swabs in your ear can damage this delicate skin. When this layer of skin becomes damaged and inflamed, it can provide an entry point for bacteria.


Earwax is the ear’s natural defence against infection, but constant exposure to moisture, cleaning and scratching can deplete the ear of cerumen, making infections more likely. Do not use cotton buds for this reason.

Outer Ear Infection - Treatment

Outer ear infections may heal on their own without treatment. Antibiotics are the most common treatment for an outer ear infection that hasn’t healed on its own and they can be prescribed by your doctor or prescribing nurse.


UK Audiologists who are highly trained to recognising ear conditions, cannot prescribe ear medication as yet so please see your doctor. If you would like another opinion, an audiologist can take pictures of the condition using a video otoscope and use a tympanometer to determine the location and nature of the problem. A hearing test my also be useful.


Doctors may also prescribe antibiotic drops mixed with steroids to reduce swelling in the ear canal. The ear drops are typically used several times a day for 7 to 10 days. A fungal infection is best treated with anti-fungal ear drops. This type of infection is more common in people with diabetes or a depleted immune system.


To reduce symptoms, it’s important to keep the ears dry while the infection is healing. Over-the-counter pain medications like paracetamol, ibuprofen or aspirin (not for children) can be used to reduce pain. In extreme cases, prescription pain medication may be prescribed. Ibuprofen and aspirin may increase tinnitus symptom.

Outer Ear Infection Prevention

  • Use a swim cap
  • Avoid scratching the ear canal, even with cotton buds
  • Avoid removing ear wax on your own

Outer Ear Infection in Children

Children have smaller ear canals which can make it more difficult for water to properly drain out of children’s ears after swimming or bathing. This can lead to increased infections. A child will usually say that their ear hurts but for those who are too young to speak, look out for the following:

  • pulling on or tugging on or near their ear
  • crying when touching their ear
  • crying more than usual, being extra fussy or having trouble sleeping
  • discharge draining from the ear

Outer Ear Infection Complications & Emergencies

If an outer ear infection goes untreated and doesn’t heal on its own, it can result in several complications:

  • Abscesses can develop. These may heal on their own, or your doctor may need to drain them. They usually become very painful and then burst on their own but you should have it looked at before it gets to this stage.
  • Long-term outer ear infections can cause narrowing of the ear canal. Narrowing can affect the hearing and, in extreme cases, cause deafness. It needs to be treated with antibiotics.
  • Ruptured or perforated eardrums can also be a complication of outer and middle ear infections. This can be extremely painful. Symptoms include temporary hearing loss, ringing or buzzing in the ears, discharge, and bleeding from the ear.
  • In rare cases, necrotising (malignant) otitis externa occurs. This is an extremely serious complication where the infection spreads to the cartilage and bone that surrounds your ear canal.

Adults with weakened immune systems are most at risk. Untreated, it can be fatal. This is considered a medical emergency, with symptoms including:

  • Severe ear pain and headaches, especially at night
  • Ongoing ear discharge
  • Facial nerve palsy (drooping of the face) on the side of the affected ear
  • Exposed bone in the ear canal

Outer ear infections should not be left to heal on their own longer than 3 days. They are normally treated very quickly and easily by antibiotics

Middle Ear Infection - Causes

Middle ear infections are caused by viruses like colds and flu and affect the middle ear (the Eustachian tube that runs behind the eardrum to the back of the nose and throat and the space that houses the small ear bones. These can become glued up. This will likely lead to symptoms of tinnitus and hearing loss.

Middle Ear Infection - Treatment

Middle ear infections will almost always clear up on their own without treatment. However, the symptoms can take some time to clear up. When they don't go away on their own usually after 3 months, minor surgical intervention may be necessary usually in the form of grommets.


The National Institute for Health and Care Excellence (NICE) recommend using Otovent during the wait period to help avoid surgery. Your audiologist should be able to provide these with special instructions of how best to use it to clear glue ear symptoms.

Inner Ear Infections

Inner ear infections are more rare and may actually be a case of inflammation, and not an actual infection. Symptoms may include tinnitus, pain, dizziness, nausea and vomiting. Inner ear problems may be a sign of something more serious such as meningitis.