Middle ear infections are also extremely common, particularly in children. The most common is acute otitis media which is characterised by a severe earache and high temperature, generally in a child, with associated deafness.
Like an abscess, once the eardrum bursts and the pus comes out of the ear the pain eases. Happily, the eardrum almost always heals once the infection settles and the hearing also returns to normal.
Longer term problems can occur when such infections are frequent, because there can be damage to the eardrum, or perhaps persistent deafness due to fluid remaining behind the eardrum (glue ear). In such cases referral to a specialist is appropriate.
A second but more serious form of middle ear infection is when it becomes chronic or long-lasting. Generally, chronic middle ear disease is associated with a smelly ear discharge and deafness, but rarely with pain.
Other significant symptoms such as tinnitus, weakness of the face or dizziness can occasionally occur. In these cases referral to an ear nose and throat surgeon is very important as the treatment usually involves surgery to remove the infection from the middle ear and mastoid bone. To ignore such disease can be potentially dangerous.
Mastoiditis is an acute infection of the mastoid bone which surrounds the ear. It is much less common than in previous decades, but certainly still occurs, especially in toddlers, and it needs urgent treatment with antibiotics once the child is admitted to hospital.
Mastoid abscess behind the ear
Infections of the inner ear are fortunately less common and are generally caused by viruses, although occasionally by secondary bacterial infection. They tend to cause problems with sudden hearing loss or dizziness.
The common cold virus is perhaps the most common cause of inner ear infections but many other viruses have also been associated with sudden deafness such as mumps, measles and herpes.
Infections of the ears that do not settle within a couple of days should precipitate a visit to your GP and if necessary a referral for specialist help.
Most ear infections will initially be treated with either antibiotic ear drops or antibiotics taken by mouth. When the infection is severe, admission to hospital may be necessary for antibiotics via a drip. In some complicated cases surgery may be the best form of treatment.
By D Bowdler and R Lloyd Faulconbridge, University Hospital Lewisham
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