top of page

Doc: How do I treat Ear Infections?

Dear friends,

Welcome back to Dr Euan's TGIF blog!

Ear infections are common, and can cause a myriad of problems for patients.

For example: ear pain, pus in ear, swollen ears, otorrhea & hearing loss to name a few.

There are many causes of ear infections; so you may well ask:

what is the best way to treat an ear infection?

For today's blogpost, let us look at various common ear infections:

  1. Otitis Externa

  2. Acute Otitis Media

  3. Chronic Otitis Media

and highlight a few more sinister / dangerous ear infections

  1. Malignant / Necrotising Otitis Externa

  2. Herpes Zoster Oticus (Ramsay Hunt Syndrome)

Q: What are the symptoms of an Ear Infection?

The symptoms of an ear infection usually start quickly and include:

  • pain inside the ear

  • a high temperature

  • being sick

  • a lack of energy

  • difficulty hearing

  • discharge running out of the ear

  • a feeling of pressure or fullness inside the ear

  • itching and irritation in and around the ear

  • scaly skin in and around the ear

These symptoms are related to inflammation and infection in the ear.

Do note that for young children and babies with an ear infection, they may also:

  • rub or pull their ear

  • not react to some sounds

  • be irritable or restless

  • be off their food

  • keep losing their balance

Most ear infections clear up within 3 days, although sometimes symptoms can last up to a week.

Q: How can I treat my Ear Infection?

To help relieve any pain and discomfort from an ear infection:


  • use painkillers such as paracetamol or ibuprofen (children under 16 should not take aspirin)

  • place a warm or cold flannel on the ear

  • remove any discharge by wiping the ear with cotton wool externally


  • do not put anything inside your ear to remove earwax, such as cotton buds or your finger

  • do not let water or shampoo get in your ear

  • do not use decongestants or antihistamines – there's no evidence they help with ear infections

If you would like to read about Dr Euan's advice on the topics mentioned above, you can read his blog posts about earwax , getting water in your ear , and decongestant nasal sprays.


Otitis Externa (OE) is a common skin infection which affects the outer ear (pinna) and the external ear canal (EAC).

It is common in hot, humid climates (like ours) and tends to be bacterial or fungal. Most OE cases respond well to topical ear drops which you can get from your GP or local pharmacy.

However, if the OE does not settle within 5 days, perhaps you should consult an ENT Specialist to have a closer look and perform an Aural Micro-suction, to clean out the debris in the EAC.

If your doctor suspects you may have an ear infection, they may perform an aural toilet (ear cleaning)

Sometimes, the ENT Doctor may take a swab sample for culture to see what microbes are causing the infection, so as to adjust the medication/ear drops eg: antibiotic ear drops will not help much if you actually have a FUNGAL ear infection, and you may need to switch to anti-fungal drops instead.

Your doctor may prescribe you medicated ear drops for fungal or bacterial infections


Acute Otitis Media (AOM) is a common ear infection, seen in infants and children; who present with fever and ear pain. This infection starts in the middle ear space, behind the ear drum and quickly becomes purulent, meaning to contain pus. Once the eardrum bursts, there is copious ear discharge, with relief of ear pain and fever.

Acute Otitis Media is commonly seen in young children and may cause fever and excessive pulling or rubbing of the ear

AOM is usually seen and treated by your GP / Family doctor with a course of oral antibiotics such as Syrup or Augmentin. As ENT surgeons, we usually do not get to see acute OM very often, as patients are well treated by their GP or Paediatrician (for young children/ infants).

It may recur a few times a year, especially if the child has frequent Acute Respiratory infections (ARI) at pre-school or kindergarten.


Chronic Suppurative Otitis Media (CSOM) is less common, but may lead to prolonged ear discharge and hearing loss, due to perforation of the Tympanic Membrane (TM) and even erosion of the Ossicular Chain (middle ear bones). Many patients report prolonged symptoms, going back months or years.

This condition should be seen and managed by an ENT Specialist, who may be able to offer you a Tympanoplasty (to repair the TM perforation) or even Ossiculoplasty (to repair the middle ear bones)

Usually, we will also order an audiogram to check on your hearing status, and check if you do have any associated hearing loss.


Malignant OE is a rare but dangerous form of Otitis Externa. It tends to affect the elderly and diabetic patients more frequently.

It is almost always associated with a specific bacteria: Pseudomonas aeurginosa.

A high index of suspicion is needed to make the diagnosis, so an EARLY referral is important.

Treatment with an aggressive 6 week course of Intravenous Antibiotics is usually needed to control this type of infection. Even so, Malignant OE carries a high morbidity and even mortality rate in the elderly.


Ramsay-Hunt Syndrome, or Herpes Zoster Oticus, is another rare but dangerous ear infection as it may damage your hearing and balance nerve and also the facial nerve, resulting in facial paralysis.

Justin Bieber recently contracted Ramsay-Hunt Syndrome and released a video on Instagram explaining his condition. you can watch the video through the link here.

Images from Justin Bieber's Instagram post where he explains his partial facial paralysis due to viral infection

It is caused by a reactivation of a latent infection by the chicken pox virus (Herpes Zoster virus) and sometimes you can see the classical "vesicles" or water bubbles on the ear lobe/pinna or even the ear drum.

Again, this needs a high index of suspicion and EARLY treatment with antivirals and steroids to prevent damage to the 7th (facial) Nerve and the 8th (hearing and balance) nerves.

So, dear friends, I hope that this blog post gives you a better idea of how ear infections may present and what you can/ should do, and also should NOT do!

If you are in doubt or would like to get a proper diagnosis and treatment, do make an appointment to see your GP or your ENT Specialist.

If you would like to book an appointment with us, you can contact us at Euan's ENT Surgery & Clinic

For more in-depth information, here are some useful references for you to look up:


1. Brown CS, Emmett SD, Robler SK, Tucci DL. Global hearing loss prevention. Otolaryngol Clin North Am. 2018;51(3):575–592. doi: 10.1016/j.otc.2018.01.006 [PubMed] [CrossRef] [Google Scholar]

2. Graydon K, Waterworth C, Miller H, Gunasekera H. Global burden of hearing impairment and ear disease. J Laryngol Otol. 2019;133(1):18–25. doi: 10.1017/S0022215118001275 [PubMed] [CrossRef] [Google Scholar]

3. World Health Organization. Childhood Hearing Loss: Strategies for Prevention and Care. World Health Organization; 2016. Available from: Accessed October 12, 2021. [Google Scholar]

4. Aarhus L, Tambs K, Kvestad E, Engdahl B. Childhood Otitis media: a cohort study with 30-year follow-up of hearing (The HUNT study). Ear Hear. 2015;36(3):302. [PMC free article] [PubMed] [Google Scholar]

5. Maharjan M, Phuyal S, Shrestha M, Bajracharya R. Chronic otitis media and subsequent hearing loss in children from the Himalayan region residing in Buddhist Monastic schools of Nepal. J Otol. 2020;15(4):144–148. [PMC free article] [PubMed] [Google Scholar]

6. Jensen RG, Koch A, Homøe P. The risk of hearing loss in a population with a high prevalence of chronic suppurative otitis media. Int J Pediatr Otorhinolaryngol. 2013;77(9):1530–1535. doi: 10.1016/j.ijporl.2013.06.025 [PubMed] [CrossRef] [Google Scholar]

7. CDC. Ear Infection [Internet]; 2021. [cited 2021 Jun 19]. Available from: Accessed October 12, 2021.

8. Szmuilowicz J, Young R. Infections of the Ear. Emerg Med Clin North Am. 2019;37(1):1–9. doi: 10.1016/j.emc.2018.09.001 [PubMed] [CrossRef] [Google Scholar]

9. McGraw-Hill. Harrison’s Manual of Medicine. 19th ed, Anthony SF, Dennis LK, Stephen LH, Dan LL, Larry J, Joseph JL, editors. In: Harrison’s Manual of Medicine. 19th ed. McGraw Hill Inc; 2017. [Google Scholar]

10. World Health Organization. World Report on Hearing. World Health Organization; 2021. License: CC BY-NC-SA3.0IGO. Available from: Accessed October 12, 2021. [Google Scholar]

11. Danisyar A, Ashurst JV. Acute Otitis Media - StatPearls - NCBI Bookshelf. Treasure Island (FL): StatPearls Publishing; 2021. [Google Scholar]

12. Schilder AGM, Chonmaitree T, Cripps AW, et al. Otitis media. Nat Rev Dis Prim. 2016;2(1):1–8. [PMC free article] [PubMed] [Google Scholar]

13. Atkinson H, Wallis S, Coatesworth AP. Acute otitis media. Postgrad Med. 2015;127:4. [PubMed] [Google Scholar]

14. Atkinson H, Wallis S, Coatesworth AP. Otitis media with effusion. Postgrad Med. 2015;127(4):1412. [PubMed] [Google Scholar]

15. Wallis S, Atkinson H, Coatesworth AP. Chronic otitis media. Postgrad Med. 2015;127(4):391–395. doi: 10.1080/00325481.2015.1027133 [PubMed] [CrossRef] [Google Scholar]

16. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964–e999. doi: 10.1542/peds.2012-3488 [PubMed] [CrossRef] [Google Scholar]

17. Vergison A. Microbiology of otitis media: a moving target. Vaccine. 2008;26:G5–G10. doi: 10.1016/j.vaccine.2008.11.006 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

18. Tesfa T, Mitiku H, Sisay M, et al. Bacterial otitis media in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis. 2020;20(1). doi: 10.1186/s12879-020-4950-y. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

19. Zhang Y, Xu M, Zhang J, Zeng L, Wang Y, Zheng QY. Risk factors for chronic and recurrent otitis media–a meta-analysis. PLoS One. 2014;9(1):e86397. [PMC free article] [PubMed] [Google Scholar]

20. Bourgeois T, Griffith C, Johnson E-C, Leblanc B, Melancon B. Barriers to current guidelines in the management of pediatric acute otitis media. J Pediatr Pediatr Med. 2019;3(3):7–24. doi: 10.29245/2578-2940/2019/3.1146 [CrossRef] [Google Scholar]

21. Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015. doi: 10.1002/14651858.CD000219.pub4 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

22. Holm NH, Rusan M, Ovesen T. Acute otitis media and antibiotics - a systematic review. Dan Med J. 2020;67:11. [PubMed] [Google Scholar]

23. Holmes AH, Moore LSP, Sundsfjord A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176–187. doi: 10.1016/S0140-6736(15)00473-0 [PubMed] [CrossRef] [Google Scholar]

24. Castro-Sánchez E, Moore LSP, Husson F, Holmes AH. What are the factors driving antimicrobial resistance? Perspectives from a public event in London, England. BMC Infect Dis. 2016;16(1). doi: 10.1186/s12879-016-1810-x [PMC free article] [PubMed] [CrossRef] [Google Scholar]

25. Chaw PS, Höpner J, Mikolajczyk R. The knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries—a systematic review. J Clin Pharm Ther. 2018;43(5):606–613. doi: 10.1111/jcpt.12730 [PubMed] [CrossRef] [Google Scholar]

26. Cunningham M, Guardiani E, Kim HJ, Brook I. Otitis media. Future Microbiol. 2012;7(6):733–753. doi: 10.2217/fmb.12.38 [PubMed] [CrossRef] [Google Scholar]

27. Wasihun AG, Zemene Y. Bacterial profile and antimicrobial susceptibility patterns of otitis media in Ayder Teaching and Referral Hospital, Mekelle University, Northern Ethiopia. Springerplus. 2015;4(1):1–9. [PMC free article] [PubMed] [Google Scholar]

28. Tadesse B, Shimelis T, Worku M. Bacterial profile and antibacterial susceptibility of otitis media among pediatric patients in Hawassa, Southern Ethiopia: cross-sectional study. BMC Pediatr. 2019;19(1). doi: 10.1186/s12887-019-1781-3 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

29. Muluye D, Wondimeneh Y, Ferede G, Moges F, Nega T. Bacterial isolates and drug susceptibility patterns of ear discharge from patients with ear infection at Gondar University Hospital, Northwest Ethiopia. BMC Ear Nose Throat Disord. 2013;13(1). doi: 10.1186/1472-6815-13-10 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

30. Molla R, Tiruneh M, Abebe W, Moges F. Bacterial profile and antimicrobial susceptibility patterns in chronic suppurative otitis media at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. BMC Res Notes. 2019;12(1). doi: 10.1186/s13104-019-4452-4 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

31. Hailegiyorgis TT, Sarhie WD, Workie HM. Isolation and antimicrobial drug susceptibility pattern of bacterial pathogens from pediatric patients with otitis media in selected health institutions, Addis Ababa, Ethiopia: a prospective cross-sectional study. BMC Ear Nose Throat Disord. 2018;18(1). doi: 10.1186/s12901-018-0056-1 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

32. Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–281. doi: 10.1111/j.1469-0691.2011.03570.x [PubMed] [CrossRef] [Google Scholar]

33. Cheesbrough M. District Laboratory Practice in Tropical Countries. Vol. 2. 2nd ed. Cambridge University Press; 2006. [Google Scholar]

34. Biemer JJ. Antimicrobial susceptibility testing by the Kirby-Bauer disc diffusion method. Ann Clin Lab Sci. 1973;3(2):135–140. [PubMed] [Google Scholar]

35. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; 23rd Informational Supplement M100-S23. Wayne: CLSI; 2013. [Google Scholar]

36. WHO. Deafness and hearing loss [Internet]; 2021. [cited 2021 Jun 25]. Available from: Accessed October 12, 2021.

37. Mulwafu W, Kuper H, Ensink RJH. Prevalence and causes of hearing impairment in Africa. Trop Med Int Heal. 2016;21(2):158–166. [PubMed] [Google Scholar]

38. Hailu D, Mekonnen D, Derbie A, Mulu W, Abera B. Pathogenic bacteria profile and antimicrobial susceptibility patterns of ear infection at Bahir Dar Regional Health Research Laboratory Center, Ethiopia. Springerplus. 2016;5(1). doi: 10.1186/s40064-016-2123-7 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

39. Argaw-Denboba A, Abejew AA, Mekonnen AG. Antibiotic-resistant bacteria are major threats of Otitis media in Wollo Area, Northeastern Ethiopia: a ten-year retrospective analysis. Int J Microbiol. 2016;2016(2016):1–9. doi: 10.1155/2016/8724671 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

40. Khatun MR, Alam KMF, Naznin M, Salam MA. Microbiology of chronic suppurative Otitis Media: an update from a Tertiary Care Hospital in Bangladesh. Pakistan J Med Sci. 37(3):821. [PMC free article] [PubMed] [Google Scholar]

41. Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Neck Surg. 2014;150(1_suppl):161–168. doi: 10.1177/0194599813517659 [PubMed] [CrossRef] [Google Scholar]

42. Wiegand S, Berner R, Schneider A, Lundershausen E, Otitis Externa: DA. Investigation and evidence-based treatment. Dtsch Aerzteblatt Online. 2019. doi: 10.3238/arztebl.2019.0224 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

43. Lee H, Kim J, Nguyen V. Ear infections: otitis externa and otitis media. Prim Care Clin off Pract. 2013;40(3):671–686. doi: 10.1016/j.pop.2013.05.005 [PubMed] [CrossRef] [Google Scholar]

44. Osazuwa F, Osazuwa E, Osime C, et al. Etiologic agents of otitis media in Benin city, Nigeria. N Am J Med Sci. 2011;3(2):95. [PMC free article] [PubMed] [Google Scholar]

45. Appiah-Korang L, Asare-Gyasi S, Yawson A, Searyoh K. Aetiological agents of ear discharge: a two year review in a teaching hospital in Ghana. Ghana Med J. 2014;48(2):91. doi: 10.4314/gmj.v48i2.6 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

46. Aboutalebian S, Ahmadikia K, Fakhim H, et al. Direct detection and identification of the most common bacteria and fungi causing otitis externa by a stepwise multiplex PCR. Front Cell Infect Microbiol. 2021;11. doi: 10.3389/fcimb.2021.644060 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

47. Gorems K, Beyene G, Berhane M, Mekonnen Z. Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia. BMC Ear Nose Throat Disord. 2018;18(1). doi: 10.1186/s12901-018-0065-0 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

48. Abera B, Kibret M. Bacteriology and antimicrobial susceptibility of otitis media at dessie regional health research laboratory, Ethiopia. Ethiop J Heal Dev. 2011;25(2):161–167. [Google Scholar]

49. Grossman TH. Tetracycline Antibiotics and Resistance. Cold Spring Harb Perspect Med. 2016;6(4):a025387. doi: 10.1101/cshperspect.a025387 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

50. Markley JL, Wencewicz TA. Tetracycline-inactivating enzymes. Frontiers Microbiol. 2018;9:1058. [PMC free article] [PubMed] [Google Scholar]

51. Reygaert CW. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018;4(3):482–501. doi: 10.3934/microbiol.2018.3.482 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

52. Endaylalu K, Abera B, Mulu W. Extended spectrum beta lactamase producing bacteria among outpatients with ear infection at FelegeHiwot Referral Hospital, North West Ethiopia. PLoS One. 2020;15(9):e0238891. doi: 10.1371/journal.pone.0238891 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

53. Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6(1). doi: 10.1186/s13756-017-0208-x [PMC free article] [PubMed] [CrossRef] [Google Scholar]

54. Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: a systematic review and meta-analysis. PLoS One. 2017;12(12):e0189621. doi: 10.1371/journal.pone.0189621 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

55. Hosain MZ, Kabir SML, Kamal MM. Antimicrobial uses for livestock production in developing countries. Vet World. 2021;14(1):210–221. doi: 10.14202/vetworld.2021.210-221 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

56. Moges F, Gizachew M, Dagnew M, et al. Multidrug resistance and extended-spectrum beta-lactamase producing Gram-negative bacteria from three Referral Hospitals of Amhara region, Ethiopia. Ann Clin Microbiol Antimicrob. 2021;20(1). doi: 10.1186/s12941-021-00422-1. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

57. Abayneh M, Worku T. Prevalence of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli: a meta-analysis report in Ethiopia. Drug Target Insights. 2020;14(1):16–25. doi: 10.33393/dti.2020.2170 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

58. WMA. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):373. [PubMed] [Google Scholar]


Dr Euan Drawing.jpeg




bottom of page