Otitis: Types, Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Complications and Prevention

This is one of the most frequent diseases in childhood and its origins are diverse.

Otitis is an inflammation of the ear . There are several types of otitis, and the most common is otitis media.

Different types of otitis

The different types of otitis are:

External otitis

Otitis externa is an inflammation of the external auditory canal, that is, the visible part of the ear.

  • Acute diffuse otitis externa: it is the most common form, it is an infectious process, usually bacterial, occasionally caused by fungi.
  • Acute circumscribed otitis externa: is synonymous with boils, is associated with infection of the hair follicle, a superficial cellulite form of otitis externa.
  • Chronic external otitis: the same as acute diffuse but of longer duration (more than 6 weeks).
  • Eczematous external otitis: may accompany typical atopic eczema or other primary skin conditions.
  • Malignant necrotizing otitis externa: it is an infection that spreads to the deeper tissues adjacent to the canal, it can include osteomyelitis and cellulitis , it is very rare in children.

Acute, chronic and eczematous external otitis are more common while necrotizing otitis are very rare conditions.

Otitis media

Otitis media is an inflammation of the middle ear.

Acute otitis media is the most common childhood disease worldwide (75 to 80% of children under 3 years of age have suffered from it).

It happens suddenly and is very painful.

  • Acute otitis media: its duration is less than three weeks.
  • Subacute otitis media: can last from three weeks to three months.
  • Chronic otitis media: lasts more than three months.

In addition, otitis media can be divided according to the type of condition, into four types:

  • Otitis media myringitis: inflammation of the outer layer of the tympanic membrane.
  • Acute suppurative otitis media: pus is present and is short-lived.
  • Secretory otitis media: It is also known as serous otitis media, with effusion or mucosa. Presence of fluid, the tympanic membrane remains unaffected and no obvious acute damage is observed.
  • Chronic suppurative otitis media: there is chronic otorrhea and perforation of the eardrum.

Internal otitis

Otitis interna involves inflammation of the inner ear.

This is the rarest form of otitis and can cause irreversible damage such as more or less severe hearing loss.

It is also called labyrinthitis or vestibular neuritis.


External otitis

  • Traumatized external canal, such as from the use of a cotton swab or some other object inserted into the ear.
  • Bacterial infections such as those caused by Pseudomonas, Staphylococcus, Streptococcus, gram-negative bacilli.
  • Fungal infections such as Aspergillus, Candida, Phycomycetes, Rhizopus, Actinomyces, and Penicillium.
  • Eczema.
  • Seborrhea.
  • Psoriasis.
  • Neurodermatitis.
  • Contact dermatitis.
  • Sensitivity to topical medications.

Otitis media

The main cause of otitis media is Eustachian tube dysfunction.

This becomes obstructed due to inflammation due to infectious or allergic processes in the pharynx, adenoids or throat that are caused by:

  • Infectious processes caused by bacteria and viruses in the respiratory tract.
  • Chronic allergies
  • Tobacco smoke and other irritants.
  • The excess of mucus and saliva that causes teething in babies.
  • Disorder of the ciliary function of the airways.
  • Repetitive ear infections.

Internal otitis

  • Infections
  • Medicines.
  • Allergies

A change in pressure during a flight or diving can also trigger an otitis media known as otitis barotrauma.

Risk factor’s

  • Traumatization of the external canal.
  • A family history of otitis.
  • The swimming.
  • Parents who smoke.
  • The use of pacifier.
  • Moisture for a long period of time, for example, standing water after bathing.
  • The swimming.
  • Hot and humid climate.
  • Use of hearing aids.
  • Primary skin disorder.
  • Advanced age.
  • Mellitus diabetes.
  • Debilitating disease.
  • PAGE.
  • Leucopenia.
  • Malnutrition.
  • Diabetes insipidus.


The doctor will take the medical history.

Subsequently, a physical examination will be carried out to verify if there is pain in the ear area or when the manipulation of the pinna is performed.

Then with the help of an otoscope it is checked to see if there is:

  • Obstruction of the ear.
  • Some kind of discharge from the ear.
  • Red ear canal.
  • Purulent discharge and waste.
  • Air bubbles.
  • Perforation of the eardrum.

The doctor may also recommend an audiometry (hearing test), also the performance of a tympanometry to evaluate the state of the tympanic membrane and the state of mobility of the chain of bones of the middle ear (the hammer, the incus and the stapes).

If some type of infection is suspected, cultures of the secretions can be ordered to show the presence of bacteria.

Radiological evaluation by X-rays or deep tissue by high resolution computed tomography, magnetic resonance, gallium scan and bone scan, to verify the degree of spread of the infection or the presence of vasculitis.

Thrombosis and necrosis of affected tissues, osteomyelitis, cranial nerve palsy, wisdom tooth eruption, basal cell or squamous cell carcinoma.


An external otitis usually involves intense itching and severe pain in the ear canal and earlobe.

Sometimes a slight flow of colorless liquid can be observed. In the most severe cases, the ear may be red and the patient may experience fever and dizziness.

In these different cases, you should see a doctor immediately. The Eustachian tube is involved during the development of otitis media.

In fact, this type of otitis often occurs after the flu or a cold.

The Eustachian tube connects the middle ear and throat and prevents bacteria or viruses from reaching the middle ear.

In some cases, it can be blocked by bacteria and viruses, causing a collection of pus that can cause a middle ear infection.

The infection usually affects children because they have a shorter Eustachian tube.

Therefore, bacteria and viruses easily migrate from the throat to the middle ear.

The accumulation of pus in the middle ear can cause a build-up of pressure in the eardrum that will generate a source of intense pain.

One or more of these symptoms usually occur:

  • Fever.
  • A hearing loss and the feeling of having a blocked ear.
  • Mood change and irritability or inconsolable crying is observed in children.
  • Disturbed sleep
  • Vomiting or diarrhea
  • Sordera (otitis barotrauma).
  • Loss of balance
  • Sickness.

Untreated acute otitis media can lead to serious complications, such as perforation of the tympanic membrane.

Therefore, it is essential to see a doctor as soon as the infection begins.


In practice, treatment is aimed at reducing inflammation of the eardrum and controlling pain and infection.

Treatment of otitis is ambulatory, except in resistant cases and in necrotizing external otitis.

The use of antipruritic drugs, antihistamines (eczematous form), anti-inflammatory drugs are recommended.

Repeated cleaning and antibiotic therapy, in most cases, resolve otitis caused by infections. Resistance is a growing problem.

Some antibiotics can be ototoxic and develop resistance in Staphylococcus and Streptococcus sp.

If a patient has recurrent episodes, the antibacterial class should be changed, in order to avoid mutation to resistant varieties.

Home remedies are used such as:

  • White vinegar.
  • Tea tree oil.
  • Grapefruit seed extract

In some cases, the doctor may put a small tube through the eardrum to drain the pus.

Wick placement can be helpful in severe cases by keeping the canal open and keeping the antibiotic solution in contact with the infected skin. Debridement can be done.

Occasionally, surgical intervention is required for chronic cases.

Surgical intervention may be necessary in resistant cases or if the cranial nerve is involved.


Otitis can spread to infect contiguous bone structures and the central nervous system, it can also spread to the pinna, causing chondritis.

Otitis can cause:

  • Total deafness.
  • Cysts (cholesteatoma)
  • Tissue hardening (tympanosclerosis).
  • Damage to the bones of the middle ear.
  • Facial paralysis.
  • Mastoiditis aguda (edema retroauricular).
  • Labyrinthitis.
  • Meningitis.
  • Brain abscess.

General prevention

  • Prolonged exposure to moisture should be avoided.
  • Preventive antiseptics should be used: acidifying solutions with 2% acetic acid (white vinegar) diluted 50/50 with water or isopropyl alcohol, or the use of 2% acetic acid with aluminum acetate (less irritating) after of swimming and bathing.
  • Treat predisposing conditions for skin pathologies.
  • Remove self-inflicted trauma to the canal with cotton swabs and other foreign objects.
  • Diagnose and treat underlying systemic conditions promptly.
  • Wearing earplugs when swimming.