What are the Main Types of Ear Infections?

Otitis Externa

There are two main types of ear infections. The first is called outer ear infection, also known as otitis externa. It affects the ear canal, which goes from the ear opening to the eardrum. An outer ear infection occurs when water enters the ear canal and becomes trapped there by wax build-up. This creates an ideal environment for bacteria to flourish. The body responds to the infection with inflammation, pain, redness, and sometimes a fever.

Otitis Media

The second type is called a middle-ear infection or otitis media. This occurs when either virus or bacteria cause infection in the middle ear. The condition is a result of the tubes inside the ears becoming clogged with mucus and fluid. Middle ear infections can be excruciating and are often accompanied by high fever, hearing difficulty, nausea, and vomiting. The fluid build-up can lead to hearing loss as all that ear fluid prevents sound from getting through. 

This type of ear infection is much more common, particularly in very young children and infants. When babies and young children pull or slap at their ears, an ear infection is quite possible. Most middle ear infections are linked to an upper respiratory infection or an allergy. Forty percent of cases are thought to be caused by bacteria, the rest by a virus.

What are the different types of Otitis Media?

There are four main types of otitis media: 
  • acute otitis media
  • recurrent acute otitis media
  • otitis media with effusion (OME)
  • chronic otitis media with effusion

Acute otitis media comes on rapidly and is defined by swelling and redness in the ear behind and around the eardrum. Ear pain, fever, and partial or complete hearing loss often occurs as a result of fluid or mucus caught in the middle ear. Repeated episodes of middle ear infections are called recurrent acute otitis media. Otitis media with effusion (OME) is the presence of fluid in the middle ear without any signs or symptoms of acute infection. This can happen when the infection clears up, but mucus and fluid continue to build up in the middle ear. This build-up creates a feeling of fullness in the ear, reducing your ability to hear clearly.  OMEs typically resolve on their own. OME is said to be chronic when middle ear effusion has been present for at least three months.

Other Symptoms of Middle Ear Infection

These are some of the most common symptoms of otitis media. Not all of them need to be present for a diagnosis of ear infection. 
  • Ear pain, often throbbing 
  • Fever 
  • Pressure or a feeling of fullness in the ear 
  • Pus from the ear 
  • Hearing difficulty in the affected ear 
  • Nausea and vomiting

Why Do Children Get Otitis Media So Often?

One of the reasons infants and young children get otitis media so often is linked to the eustachian tube. Because the eustachian tube is more horizontal than it is in adults, it prevents fluid to flow smoothly. When it isn't working properly, mucus is unable to drain from behind the eardrum. Instead, it stays stuck and causes pain and pressure. This situation often leads to infection. As children get older, the eustachian tube becomes more vertical and begins to drain better.

How to Prevent Otitis Media?

The key to preventing otitis media is to limit the build-up of fluid. Proper diet can play an essential role in reducing the risks. Food allergens, such as cow's milk and sugar, can lead to excess mucus and fluid. Eliminating these foods from the diet can be incredibly helpful. It is also helpful to reduce exposure to environmental allergens e.g. second-hand smoke.

Diagnostics and Treatment

It is essential to take all ear infections and ear pain seriously. A paediatrician or an ENT specialist is most qualified to make the diagnosis of otitis media. They have the proper instruments to look inside the ear. If you have an acute middle ear infection, your eardrum will be very red. If there is pus present in the inner ear as a result of the infection, the eardrum bulges slightly forward. This bulging leads to an increased risk of eardrum perforation.

To protect your eardrum from rupturing and speed up the healing process, the doctor may prescribe medications. Your physician may recommend over-the-counter or prescription ear drops to help relieve your symptoms. In some cases, antibiotics may be necessary to clear the infection. While the acute inflammatory phase lasts about two to three days, the entire healing process takes about two to four weeks. Medications, when prescribed appropriately, can shorten the duration of the infection.
To be on the safe side, be sure to visit your GP or ENT if you have ear pain or hearing loss. Be especially alert for signs of middle ear infections with babies and young children, who often pull on their ears when suffering from ear pain. If your child shows signs of ear infection, do not delay, consult your doctor as soon as possible.

As a large percentage of otitis media is viral, antibiotic therapies are not always the appropriate course of treatment. Your doctor can determine whether the likelihood of bacterial or viral infection is higher based on your symptoms.


Diet plays a vital role in helping to relieve symptoms of otitis media. Follow these dietary suggestions to help alleviate pain and prevent recurring infections. You may need to make drastic dietary changes for optimal results.

Recommended Foods

You can help your body clear a middle ear infection by strengthening your immune system. 
  • Follow a healthy diet centered around fresh fruits, vegetables, whole grains, and high-quality protein, to make your immune system stronger
  • Drink plenty of water to thin mucus secretions 
  • Essential fatty acids, found in cold-water fish, flaxseeds, and flaxseed oil, are useful in reducing the inflammation or the allergies that are often present 
  • Switch bottle-fed babies to a non-dairy formula, with your doctor's supervision 
  • Breastfeeding mothers should avoid common allergens, such as cow's milk.

Other Recommendations

  • To prevent fluid accumulating in the eustachian tube, when bottle-feeding children, prop them at a thirty-degree angle or more rather than being flat on their backs
  • Avoid exposure to second-hand smoke. 
  • Avoid using cotton swabs, as they pack wax into the ear canal 
  • During an infection, don't allow moisture into your ears 
  • To decrease pain, apply heat locally. Try a hot-water bottle wrapped in a towel or blow a hairdryer onto the affected ear.


If middle ear infection occurs frequently, it can lead to more severe consequences. The formation of scar tissue on the eardrum is one such complication. The scar tissue can lead to hearing difficulty and eventually ruptured eardrums. If the tiny ear bones called ossicles in your inner ear are damaged or deformed, this can cause hearing loss.

The high potential for complications makes a diagnosis by a doctor critical. Never disregard ear pain or hearing loss, and consult an ear, nose, and throat specialist immediately.