Otitis is an "inflammation of the ear commonly caused by a" bacterial, viral, or fungal infection.

According to the part of the organ concerned, it is possible to have:

  • otitis externa
  • otitis media

Otitis externa it is an "inflammation of the external auditory canal, the canal that connects the auricle with the eardrum.

It is often caused by contact (for example, swimming) with water polluted by bacteria or irritants, but it can also be caused by small wounds on the walls of the ear canal caused during normal cleaning operations.

Otitis media it is an "infection of the middle ear", a cavity inside the eardrum, in which fluid can accumulate.

It is caused by viruses or bacteria and often appears as a complication of upper respiratory infections. This happens because there is a connection between the middle ear and the nasopharynx, a canal, said Eustachian tube, which has the function of balancing the pressure of the air present inside the ear with the external one and to facilitate the drainage of mucus from the middle ear. In case of upper respiratory tract infection, the germs present in the secretions of the Nasopharynx can pass into the middle ear and cause infection. In other cases, obstructions and / or changes in the Eustachian tube cause the infection.

Otitis media is a typical childhood disease, particularly common between 6 and 15 months of age. Almost all preschool children suffer from it at least once, and just under half will have at least three episodes of otitis within the first three years of life.Fluid can often be present in the ear of children affected by otitis media otitis media with effusion, a form that affects approximately 90% of preschool children.


Otitis externa can give rise to a number of disorders (symptoms) such as:

  • ear pain
  • itch and irritation within the ear canal
  • feeling of pressure inside the ear
  • elimination of aqueous liquid or pus from the ear
  • decreased hearing (usually limited)
  • enlargement and pain in the lymph nodes present behind the ears

These symptoms (symptoms) usually last a few days but, in limited cases, can persist for several months.

Otitis media causes disorders (symptoms) that can develop rapidly and resolve within a few days (acute otitis media). They include:

  • ear pain
  • feeling of plugged ears, whistling or buzzing
  • fever
  • slight hearing lossresulting from accumulation of fluid behind the eardrum (otitis media with effusion)
  • perforation of the tympanic membranea and discharge of pus (only in some cases)

In very young children, who are unable to communicate ear pain, the tendency to repeatedly touch the ear, cough, cold, irritability, lack of response to ear can be considered telltale signs of otitis media. sounds, loss of balance, diarrhea.

Children with fluid-accumulated otitis media (effusion) often tend to suffer from repeated episodes (recurrent acute otitis media).


Otitis is caused by different factors depending on whether it is otitis externa or otitis media.

Otitis externa it can be caused by:

  • bacteria, Which Pseudomonas aeruginosa or Staphylococcus aureus present in polluted waters with which it comes into contact
  • fungal species, Which Aspergillus spp or from Candida albicans
  • herpes viruses
  • seborrheic dermatitis
  • allergic phenomena, caused by secretions / products / materials that come into contact with the ear such as, for example, sweat, shampoo, ear plugs

The onset of otitis externa can be favored by local trauma of the external auditory canal such as, for example, those caused by the use of cotton buds to clean the ears.

Otitis media It is a frequent complication of upper respiratory tract infections (colds, pharyngitis) caused by viruses and bacteria and is a consequence of the penetration of germs into the middle ear through the Eustachian tube. It can be caused by:

  • bacteria, are the most common cause, especially species Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catharralis. Between these, S. pneumoniae it is more frequently associated with severe forms, while H. influenzae is more often isolated in cases of repeated (recurrent) otitis over time
  • virus
  • allergies (allergic rhinitis), can cause obstruction of the Eustachian tube
  • enlargement of the adenoids, can cause obstruction of the Eustachian tube

Certain genetic diseases such as Down syndrome, cleft palate, and cystic fibrosis can increase the risk of otitis media.


Otitis is ascertained (diagnosed) not only on the basis of the disorders (symptoms) it causes but also by means of an instrument, called otoscope, used by the doctor to examine the ear and highlight any signs of inflammation in the external auditory canal (otitis externa), in the eardrum membrane or the presence of fluid in the middle ear (otitis media).

If the disturbances do not decrease or cease following treatment, in doubtful cases or in the event of complications, the doctor may subject the patient to other diagnostic tests such as:

  • tympanometry, instrumental examination that measures how the eardrum reacts to changes in air pressure.The examination may indicate the presence of exudative fluid in the middle ear (otitis media with effusion), perforation of the eardrum and problems affecting the Eustachian tube
  • audiometry (audiometric examination), an investigation that is used to assess the degree and hearing capacity of the person. It is a non-invasive examination conducted using headphones that emit sound signals inside an audiometric booth

On rare occasions, if the doctor believes that the infection may have spread from the ear to the surrounding regions, it is possible to use other instrumental methods such as:

  • computed axial tomography (CT scan), an imaging technique that allows you to examine sections and layers of parts / organs of the human body
  • magnetic resonance, a technique that provides detailed images of the human body using magnetic fields and radio waves


Otitis can often heal spontaneously within a few days without the need for antibiotic treatment. Pain relief and fever, if present, can be relieved by using paracetamol and ibuprofen pain relievers.

In the case of otitis externa of allergic origin, it is advisable to eliminate everything that can cause allergy (hearing aids, plugs, earrings).

If, after a few days of treatment with painkillers, the symptoms persist and / or worsen, the doctor may decide to prescribe antibiotics.

Antibiotic treatment is recommended, in the opinion of the doctor, especially in children under the age of 6 months and / or in adults with other diseases.

If "otitis externa caused by fungi" is ascertained (diagnosed), the doctor can decide on the administration of so-called antifungal drugs (also called antifungals).

In children with repeated (recurrent) otitis media there may be a need to insert a tube into the eardrum (ventilation tube) to help drain the collected fluid.

In the case of enlarged adenoids causing repeated episodes of otitis media, their surgical removal may be considered.


Otitis externa rarely causes complications, however, in rare cases there may be:

  • bacterial infections, such as abscesses or cellulitis, near or inside the external auditory canal damaged by otitis
  • narrowing of the ear canal by accumulation of dead epithelial cells inside it
  • perforation of the eardrum due to otitis media
  • malignant external otitis, a very rare complication in which the infection spreads to the bone surrounding the ear canal

Serious complications of otitis media are not common. Very young children (in whom the body's defense system is still immature), however, may be at risk for local, regional or intracranial complications which include:

  • labyrinthitis, inflammatory disorder of the inner ear, or labyrinth. Causes balance disorders, hearing loss and ringing in the ears (tinnitus)
  • mastoiditis, inflammation of the bone located behind the ear (mastoid) by direct spread of infection. This disease is characterized by high fever, swelling and pain behind the ear, headache, hearing loss. Usually, it resolves administering antibiotics but, in rare cases, surgery may be required
  • cholesteatoma, chronic inflammation of the middle ear associated with an abnormal skin growth (desquamated skin cyst) with damage to the bone structures. Requires surgery
  • speech disorders, can intervene in very young children with repeated otitis media that has temporarily impaired their hearing
  • facial paralysis, swelling associated with otitis which can cause facial nerve compression. This condition, however, usually resolves when the infection heals
  • meningitis, a serious but, fortunately, very rare complication of otitis media. It can occur if the infection spreads from the ear to the meninges (protective membranes that cover the brain and spinal cord)
  • brain abscess, collection of pus inside the brain. It is a very rare and serious complication that requires surgery


Numerous factors can help prevent the onset of otitis externa:

  • avoid cleaning the ear canal with cotton swabs or other objects that can cause microtrauma
  • keep your ears dry and clean
  • use ear plugs if you swim regularly
  • have any plug of cerum removedand the doctor
  • remove hearing aids, earplugs or earrings in case of an allergic reaction

Although it is not possible to prevent otitis media in children, certain behaviors can help reduce the risk of infection:

  • make sure the child has vaccinated according to the national vaccination schedule, with particular regard to the hexavalent vaccine and the pneumococcal vaccine
  • vaccinate the child versus the "fluto
  • avoid exposing your child to cigarette smoke
  • prefer breastfeeding instead of artificial feeding, where possible
  • avoid feeding the baby while lying on his back and avoid using the pacifier between 6 and 12 months


NHS Choices. Ear infections (English)

Mayo Clinic. Swimmer "s ear (English)

Mayo Clinic. Ear infection (middle ear) (English)

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