An ear infection (otitis) is a painful inflammation of the ear that affects millions of people every year, with a particularly high prevalence in young children. Whether bacterial, viral or caused by a pressure shock, it undermines quality of life, hearing and sometimes balance.
To treat it properly, you first need to understand how our auditory system is built and how infections spread through it. This encyclopedic guide helps you identify each condition precisely.
How is the ear structured in relation to the different ear infections?
To understand how ear infections arise, we need to look at the ear as a system of three interdependent parts. Each zone has its own anatomy and, therefore, its own form of infection.
[External Ear] ──► [Middle Ear] ──► [Inner Ear]
(Pinna / Canal) (Eardrum / Ossicles) (Cochlea / Labyrinth)
│ │ │
📑 Otitis Externa 📑 Middle Ear Infections 📑 Otitis Interna
What is the link between the external ear and otitis externa (or “swimmer’s ear”)?
The external ear divides into two parts: the pinna (visible elastic cartilage) and the external auditory canal, which works like an acoustic horn leading to the eardrum. The skin of this canal houses sebaceous and ceruminous glands that produce earwax, a natural protector.
Otitis externa sets in precisely in this area, between the pinna and the eardrum.
- Causes: It results from a bacterial infection (Staphylococcus aureus or Pseudomonas aeruginosa) or, more rarely, a fungus (mycosis). It is largely favoured by scratching, aggressive use of cotton buds or water stagnating after swimming (hence its nickname of summer ear infection).
- Symptoms: Intense pain on touch, swelling of the canal, redness and sometimes a purulent discharge.
- The severe form: Malignant or necrotising otitis externa. It mainly affects people with diabetes or a weakened immune system and can spread as far as the temporal bone.
What are the characteristics of middle ear infections?
The middle ear is an air-filled cavity comprising the eardrum, the ossicles (hammer, anvil, stirrup), the mastoid and the Eustachian tube. The latter connects the ear to the back of the nose and serves to balance the pressure on either side of the eardrum. Middle ear infections are an inflammation of the mucous lining of this cavity. They fall into three main categories:
1. Acute otitis media (AOM)
This is the childhood infection par excellence, mainly affecting children from 3 months to 3 years, whose Eustachian tube is still immature and too permeable. It usually follows a rhino-pharyngitis.
There are two forms of AOM:
- Congestive otitis: Simple inflammation without fluid behind the eardrum.
- Purulent otitis: Accumulation of pus in the eardrum cavity. The eardrum may eventually perforate spontaneously, releasing yellowish secretions.
Warning signs in infants: As symptoms are sometimes atypical, watch for unexplained crying, night waking, strong irritability, refusal of the bottle and digestive problems (vomiting, diarrhoea).
2. Serous otitis media
Very common in children under 3, it is characterised by an accumulation of fluid (serous secretions) behind the eardrum, caused by poor ventilation of the Eustachian tube or swollen adenoids.
- Distinctive feature: Unlike AOM, it causes neither fever nor acute pain.
- Main risk: It causes significant hearing loss. If it persists, it can lead to language delays in children, requiring the placement of grommets (transtympanic drains).
3. Chronic otitis media
If inflammation or infection of the mucosa persists beyond 3 months, the ear infection becomes chronic. It is often linked to the germs Pseudomonas aeruginosa and Staphylococcus aureus and is accompanied by a permanent perforation of the eardrum.
| Form of chronic otitis | Description & Symptoms | Main treatment |
| Simple chronic otitis | Perforated eardrum, hearing loss, discharge of pus during colds or after swimming. | Surgical (tympanoplasty to graft the eardrum). |
| Cholesteatomatous otitis | Dangerous accumulation of skin debris (cholesteatoma) in the middle ear, which destroys the bony structures. Risk of severe vertigo. | Mandatory surgery (removal of the skin and reconstruction of the ossicles). |
When should you worry about inner-ear and barotraumatic infections?
Some forms of ear infection fall outside the scope of classic ENT infections and represent medical emergencies or specific functional conditions.
Inner ear infection (or labyrinthitis)
The inner ear houses the cochlea (which turns sounds into nerve signals for the brain) and the vestibular apparatus (made up of semicircular canals that detect the position of the head and manage balance).
An inner ear infection is a rare but serious complication of an acute otitis media that has evolved unfavourably. The infection spreads to the labyrinth, disrupting the coherence between the signals from the ear and the other sensory receptors.
- Symptoms: Violent spinning vertigo, tinnitus and hearing loss.
- Risk: Without prompt medical care, it can destroy the auditory nerve and cause permanent hearing loss.
Barotraumatic otitis
This form is not caused by a microbe, but by a pressure shock. It occurs during aircraft descents, scuba diving, or take-off. If the Eustachian tube is blocked (because of a cold or an allergy), the pressure difference deforms the eardrum.
- Symptoms: A feeling of a blocked ear, sharp pain (earache), bleeding of the eardrum mucosa, vertigo and sometimes a ruptured eardrum.
Where can you find natural solutions to relieve ear infections?
Now that you can put a name to the various ear complaints, it is time to take action. Although a diagnosis by a doctor or ENT specialist remains essential (particularly to check the state of the eardrum before any instillation), gentle medicine such as homeopathy offers excellent results in prevention or as a therapeutic complement.
Discover our practical, detailed fact sheets to treat yourself naturally:
- Prevention and everyday naturopathic habits – Learn the right way to blow your nose, ear hygiene without cotton buds and decompression techniques on planes.
- Guide to phytotherapy and aromatherapy against infection – Discover how to use grapefruit seed extract, essential oil synergies and plant buds (gemmotherapy).
Sources
- https://www.ameli.fr/assure/sante/themes/otite-moyenne-aigue/reconnaitre-otite-moyenne-aigue
- https://www.ameli.fr/assure/sante/themes/otite-sereuse/symptomes
- https://www.ameli.fr/assure/sante/themes/otite-externe/symptomes
- https://www.msdmanuals.com/fr/professional/affections-de-l-oreille,-du-nez-et-de-la-gorge/troubles-de-oreille-externe/
- https://www.vidal.fr/maladies/nez-gorge-oreilles/otite-douleur-oreille-adulte/causes.html
Frequently asked questions (FAQ) about ear infections
Why do children get more ear infections than adults?
It’s simply a question of anatomy. In young children (especially before age 3), the Eustachian tube is shorter, wider and much more horizontal than in adults. Germs from a cold or rhino-pharyngitis therefore travel very easily from the nose to the middle ear. In addition, their immune system is still learning.
How can you tell otitis externa from acute otitis media?
The best test is touch: if you gently pull on the pinna of the ear or press on the small cartilage at the entrance of the canal (the tragus) and the pain is excruciating, it is generally otitis externa. Otitis media, on the other hand, hides behind the eardrum. It often follows a cold, comes with fever and gives a feeling of a heavy or throbbing ear, without simply touching the outside triggering sharp pain.
What is “swimmer’s ear”?
Swimmer’s ear is the common name for diffuse otitis externa. It occurs mainly in summer because of water stagnating in the ear canal after swimming in a pool or the sea. The residual moisture changes the pH of the canal skin, creating an ideal playground for the proliferation of bacteria (Pseudomonas) or fungi.
Is serous otitis painful?
No, and that’s exactly its trap. Serous otitis is characterised by fluid stuck behind the eardrum, but without active infection or acute inflammation. There is therefore neither fever nor sharp pain. The only symptom is hearing loss (a feeling of a blocked ear). In children, it often goes unnoticed until it causes a language delay or attention difficulties at school.
What are the warning signs of a serious inner ear infection?
An inner ear infection (or labyrinthitis) is a medical emergency. You must see a doctor immediately if the ear infection comes with severe spinning vertigo (the feeling that the room is turning), intense tinnitus, nausea or a sudden, profound drop in hearing. This means the infection has migrated to the labyrinth and threatens the auditory nerve.
