What is Otitis (medium, external, internal), symptoms and remedies


What is otitis?

The term otitis refers to inflammation in the middle or outer ear , as well as in the ear mucosa or eardrum. Its main characteristic is ear pain and is caused mainly by the entry of microorganisms in the ear.

It is more common in children between the ages of 6 and 36 months, although it can happen at any age, usually due to harmful hygiene habits. In general, it is a common problem and easy to solve , however, whenever the pain extends, precautions must be taken to avoid further complications.

Otitis can be very painful due to the accumulation of fluids inside the middle ear (formerly called the middle ear) and in the eardrum.

In the International Classification of Diseases (ICD), otitis is found as H60, H65-H67 and H83.0.

Anatomy of the ear, location and types of otitis

Otitis can be classified according to the part of the ear that is affected. Therefore, in order to understand the types of otitis, it is first necessary to be aware of the structures of the ear. Are they:

  • Outer ear;
  • Middle ear;
  • Inner ear;
  • Hearing tube (Eustachian tube).

Currently, these parts have come to be called “ears” (external, medium, internal), however, due to the large number of people who use the name “ear”, this text accepts both forms as valid.

Understand better about each of these structures:

External ear or ear

This part comprises the ear itself, anatomically known as the auricular pavilion, and ends where the eardrum is located. The function of this pavilion is to form a channel (called auditory) through which the sound passes and is redirected to the middle ear.

When there is inflammation and infection of the external ear, it is called otitis externa , the easiest form of otitis to treat. This type of otitis is popularly known as “swimmer’s ear”.

Ear or middle ear

It starts with the eardrum, a thin membrane that vibrates with the mechanical energy of the air (sound), and transmits this vibration to the ossicles called hammer, anvil and stirrup. Interestingly, these are the smallest bones in the human body.

In the middle ear, there is also the auditory tube, formerly called the Eustachian tube. We will talk about it later.

The inflammation in this structure is called otitis media and usually has a slightly more complicated resolution than the external one. In addition, it can be divided into two types:

When there is an accumulation of fluid in the middle ear, without secretion, it is called congestive otitis (hyperemic) and when there is a perforation of the eardrum with release of secretion, it is called suppurative otitis (also known as serous otitis).

Inner ear or ear

This is where the cochlea is located, a structure that looks like a snail shell. Inside it, there is a liquid and hair cells that move with the vibrations of the air (amplified by the eardrum, hammer, anvil and stirrup), which transduce these vibrations into nerve impulses. These impulses are sent to the brain, which captures and interprets them, generating an understanding of sounds.

It is within the inner ear that the structures responsible for the balance of the body are. Therefore, otitis within this structure is known as labyrinthitis , which causes different symptoms from other otitis. Therefore, it is often considered as another disease and will not be addressed in this text.

Hearing tubing

The auditory tube is a passage of air that is connected to the nasopharynx (the innermost portion of the nose) and serves to equalize the pressures of the external and middle ears. Often, there may be an accumulation of secretions in this channel, which causes differences in pressures and causes discomfort for the patient.

This structure is closed most of the time, and opens during moments of yawning, sneezing, chewing, among others that involve the jaw.

Duration of otitis

Otitis can also be classified according to its duration. While most ear infections resolve in a short time, there are others that take longer and increase the risk of major complications when left untreated. Understand:

Acute otitis

Acute otitis lasts about 2 weeks and resolves easily, but when it occurs more than 4 times a year, it is also called recurrent otitis . It usually happens when the excess fluid and mucus in the ear is not drained naturally, starting a new infection process.

Chronic otitis

When the inflammation lasts more than 4 weeks, it is considered chronic. On these occasions, it is common for inflammation to worsen over time and not improve on its own, with the need for medical attention.

Causes of otitis

Generally, what causes otitis is related to the portion of the ear that is compromised. What these ear infections have in common is the presence of microorganisms such as viruses, fungi or bacteria, which cause infection in the area.

What are the causes of otitis externa?

Otitis externa is caused, in most cases, by excessive humidity and wounds that open due to hygiene habits such as the use of a cotton swab or the introduction of other foreign objects, which push the wax into the ear.

These conditions are conducive to the proliferation of fungi and bacteria , responsible for infection and consequent pain.

It is common, even, that otitis externa appears after vacation at the beach or pool, or even in swimmers, due to the constant presence of water in the ear, which facilitates the appearance of fungi in the external region of the ear.

Other less frequent causes of otitis externa are seborrheic dermatitis and acne on the ear.

What about otitis media?

In the case of otitis media, the infection occurs by another route: viruses and bacteria enter the inner ear through the auditory tube , due to the accumulation of mucus in the nasopharynx, the innermost part of the nose, directly connected to the tube. The nasopharynx is usually congested, that is, full of mucus, when the patient has a cold or the flu.

The microorganisms go up through the auditory tube and reach the middle ear, which, as a consequence, accumulates pus.

Therefore, it can be said that otitis media is often the result of a cold , respiratory infection or pharyngitis , although it can also be caused by the accumulation of mucus characteristic of allergic processes such as rhinitis and sinusitis .

This type of otitis is more common in children precisely because the auditory tube of small children is considerably smaller than that of adults and has an angle that facilitates the passage of fluids and secretions through the canal.

Risk factors

There are some risk factors that contribute to the development of otitis. Are they:

  • Lack of breastfeeding: Children who do not breastfeed have an impaired immune system in relation to children who are fed breast milk;
  • Smoking: Cigarette smoke makes the respiratory system less resistant to infection, and this is also true for secondhand smoke;
  • Children attending daycare centers: Due to increased exposure to viruses and bacteria when in contact with other people and environments;
  • Winter: When it is cold, it is common for people to keep indoors, facilitating the spread of infectious agents;
  • Repeated respiratory infections : Several respiratory infections can lead to the accumulation of mucus, which is one of the causes of otitis media;
  • Gastroesophageal reflux: Due to the possibility of gastric contents reaching the nasopharynx, initiating an inflammation process.

Groups of risk

The groups most likely to develop ear infections are swimmers and children , as they have more contact with factors that help the development of the disease.


Because they are in constant contact with water, swimmers are more prone to external otitis, due to excessive moisture in the ear, which facilitates the proliferation of fungi.


There are two reasons why children are more prone to otitis: the first is the length of the auditory tube, smaller than that of adults, and the second is the immune system still in formation, which causes them to have viral infections. and bacterial more easily.

Is otitis transmissible?

Although in most cases it is caused by microorganisms, otitis itself is not transmissible . However, the causes of the infection can be transmitted through secretions, contact with contaminated surfaces, sharing of objects for personal use, among others.

Although catching a cold or other infection is no guarantee of otitis, it often comes as a consequence, which can make it appear “transmissible”. However, it depends a lot on the person’s immune system and age.

Otitis symptoms

The main symptom of any otitis is ear pain , which can be caused both by the pressure difference in the outer and middle ear and by the presence of microorganisms.

Otitis externa

The main symptoms of otitis externa are:

  • Intense pain;
  • Itching in the ear;
  • Difficulty in hearing (muffled sound);
  • Temporary hearing loss due to obstruction of the ear canal;
  • Secretions;
  • Heat, redness and swelling in the ear canal;
  • Flaking around the ear canal that causes it to narrow (stenosis);
  • Lack of wax (cerumen).

Otitis media

In otitis media, in addition to pain, symptoms similar to those of respiratory infections can be noted:

  • Swelling of the mucous membranes of the nose;
  • Increased production of mucus (phlegm);
  • Accumulation of fluid in the middle ear;
  • Pressure in the ear;
  • Swollen, reddish and arched eardrum;
  • Ringing in the ear;
  • Fever.

How to identify otitis in babies and young children?

Often, little ones do not know how to express what they are feeling, and parents or guardians need to be on the lookout for signs that there may be something wrong. Some of them are:

  • Pull the little ear frequently;
  • Crying when touching the ear / ear;
  • Fever;
  • Lack of appetite;
  • Babies can cry and refuse to breastfeed;
  • Irritability;
  • Difficulty sleeping;
  • Secretions coming out of the ear;
  • Some children may experience diarrhea, nausea and vomiting.

When secretions leave the ear, it is a sign that there has been a small perforation in the eardrum. This is not something serious, as the eardrum has a great capacity for reconstruction (the child will not lose hearing), but this is definitely a sign that he should go to the doctor , to avoid more serious complications.

How is otitis diagnosed?

The specialist who treats diseases of the ear, nose and throat is the otorhinolaryngologist , who can perform the diagnosis of otitis. In general, just a history of symptoms and a clinical evaluation is enough to determine the presence of otitis, without the need for laboratory tests or imaging.

The doctor must examine the ear with an otoscope , a device with a light and a magnifying glass, whose function is to allow the specialist to clearly see the conditions inside the ear. This test doesn’t hurt , but young children can be resistant because they have no idea what’s going on in their ears.

When otitis does not improve over time, your doctor may order other tests, such as:


Tympanometry is an exam that measures how the eardrum reacts to differences in air pressure. It consists of placing a probe in the ear, which changes the air pressure while transmitting sound into the ear.

The probe measures the way the sound reflects inside the ear and how pressure affects that index. When the sound reflected back is little under high pressure conditions, it is a sign that there is infection.


In tympanocentesis, fluid drains from the middle ear, which is sent for analysis. This helps to find out which virus or bacteria is responsible for the infection.

Computed tomography

When there is a suspicion that the infection has spread further into the ear canal, an image exam called computed tomography is used, which takes several radiographs of the skull, allowing a clearer view of the ear.

Does otitis have a cure? What is the treatment?

Fortunately, otitis is curable , and it is often easily achieved through simple clinical treatment. In rare cases, there is a need for surgical treatment, but only when there are signs of recurrent otitis.

Understand better how the treatment for otitis is done:

Otitis Drugs

Often, doctors prescribe anti-inflammatories and painkillers like ibuprofen for the treatment of otitis symptoms, but each case is different and there may be a need for other types of treatment. In cases of otitis media caused by bacteria, it is also common to prescribe antibiotics , especially in the presence of fever , bilateral otitis (in both ears), in children under 2 years of age and in cases that do not improve within 72 hours. hours.

Antibiotics commonly indicated in these cases are:

  • Amoxicillin ;
  • Cefuroxime ;
  • Ceftriaxone ;
  • Clarithromycin ;
  • Azithromycin ;
  • Erythromycin .

In otitis externa, medications often come in the form of drops, for topical use. In more disabled individuals, the use of oral medications may be necessary.


Acetylsalicylic acid ( Aspirin ) should never be given to children, as it is associated with Reye’s Syndrome, a serious disease with high mortality.

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Home treatment

There are homemade methods to relieve otitis, but these are not a substitute for the clinical treatment prescribed by a doctor, because in addition to there being no evidence of their effectiveness, there is also no guarantee that they are safe methods. Therefore, always consult your doctor before doing any type of treatment, even the homemade one.

Treatments that involve placing a liquid or foreign object in the ear are not recommended , as they can aggravate the situation.

Some homemade measures to be taken are:

  • Make hot compresses in the ear for 15 minutes, avoiding catching cold soon after;
  • Use cotton balls or ear protectors on the outside of the ear to prevent water from entering the ears when bathing;
  • Wear a swimming cap;
  • Avoid scratching the ear, even with cotton swabs;
  • Avoid removing earwax (cerumen), which is a natural ear protection layer;
  • After bathing or swimming, dry the ears with your finger wrapped in a towel, without applying too much force to the eardrum region.


In more severe cases of otitis media or the development of abscesses, surgical interventions may be necessary.

When there is recurrent otitis, that is, it happens more than 4 times a year, doctors can choose to make a small perforation in the eardrum to drain the liquid present in the middle ear, in addition to placing a small tube in this perforation, to prevent future accumulations. . This process is called myringotomy or tympanostomy .

In the case of abscesses, the intervention consists of draining its contents.

Complications and emergency symptoms

When otitis does not resolve on its own and is not treated, some complications can occur. Are they:

  • Abscesses: Poor treatment of otitis externa can lead to abscesses, pockets of inflamed tissue containing pus, which often require surgical drainage. In more extreme cases, the abscess may appear in the brain, configuring a serious complication;
  • Breaks and perforations: The use of foreign objects in the outer ear and the presence of liquids in the middle ear can cause perforation of the eardrum, an extremely painful complication that can cause hearing loss (temporary or permanent, depending on the severity of the injury);
  • Hearing loss: Frequent infections of the external ear can lead to narrowing of the ear canal, which considerably worsens hearing;
  • Meningitis: When the untreated infection progresses, it can reach the meninges, a membrane that covers the central nervous system;
  • Mastoiditis: In the same way that the infection can advance to other tissues, it can advance to the mastoid process (part of the temporal bone, just behind the ear) and destroy it internally;
  • Cholesteatoma: Growth of middle ear tissue, which can lead to the destruction of ear ossicles (hammer, anvil and stapes);
  • Labyrinthitis: When the infection progresses to the inner ear, it can become a labyrinthitis, the main symptoms of which are vertigo, dizziness and loss of balance.

Emergency symptoms

An emergency situation that occurs as a consequence of untreated otitis is called malignant external otitis , which mainly affects people with weakened immune systems (children, the elderly, people undergoing chemotherapy or immunosuppressive treatment).

It happens when the infection advances more internally in the ear and reaches the adjacent tissues, damaging bones such as the temporal, mandible, as well as nerves of the skull.

The main symptoms that such a process may be happening are:

  • Severe pains in the head and ear, especially at night;
  • Output of secretions through the ear constantly;
  • Facial nerve palsy (Bell’s palsy), in which the side of the face with the affected ear loses movement;
  • Bone exposed in the ear canal.

When any of these symptoms are detected, a doctor should be contacted immediately , before the infection causes irreversible damage to other tissues and nerves.

How to prevent otitis?

The best way to prevent otitis is to prevent common infections such as colds and flu. Some measures include:

  • Do not share glasses and personal effects;
  • Wash your hands with soap and water frequently;
  • Keep the environments open and well ventilated;
  • Avoid cigarette smoke;
  • Keep vaccines against common viruses and bacteria up to date ( Haemophilus influenza , Streptococcus pneumoniae and Influenza ).

Measures related to other causes of otitis are:

  • Avoid cleaning your ears with cotton swabs and other objects that can damage the eardrum;
  • Use ear protectors to bathe and swim caps in the pool and / or sea;
  • Dry the ears only with the towel after swimming or bathing;
  • Tilt your head and tap on one side to remove water from the ear canal;
  • Limit the use of in-ear headphones;
  • Avoid letting the baby breastfeed lying down, as the horizontal position favors the passage of liquids to the auditory tube;
  • When cold or during allergic attacks (rhinitis and sinusitis), flushing your nostrils with saline several times a day helps to prevent mucus buildup.