Otitis (inflammation of the ear)

Otitis means inflammation of the ear. It is an umbrella term, not one diagnosis, covering a sore ear canal after swimming and fluid behind a child’s eardrum for months.

What otitis is, and what it is not

The word depends on which part of the ear is inflamed. Otitis externa affects the ear canal, often called swimmer’s ear. Otitis media affects the middle ear, behind the eardrum. It covers acute otitis media, a sudden infection with fluid and inflammation, and otitis media with effusion, where fluid lingers after the infection settles and dulls hearing.

So otitis is not always an infection needing antibiotics, and not only a childhood problem. It can also reach the inner ear, causing dizziness and hearing change rather than pain.

Signs and symptoms

• Ear pain, often worse when lying down
• A blocked or full feeling, with muffled hearing
• Fluid or pus draining from the ear
• Fever, and in babies fussiness, broken sleep or ear-tugging
• Pain when the outer ear is touched or pulled, pointing to the canal

Young children often cannot describe this, so an adult may notice poor hearing first.

What raises the risk

Some things cannot be changed:

• Young age, which the Canadian Paediatric Society lists among the strongest risk factors
• Cleft palate, and a family history of otitis media
• Living in a community with a high burden of ear disease. Inuit children in Nunavik averaged 5.9 episodes before their fifth birthday

Others can often be worked on, usually with support from a health care team:

• Cigarette smoke in the home, and household crowding
• Feeding patterns the Canadian Paediatric Society names: shorter breastfeeding, bottle feeding while lying down, and pacifier use
• Immunisation status. In Nunavik, minor middle ear abnormalities at age 5 were found in 34% of unvaccinated children and 22% of those given the 7-valent pneumococcal vaccine

How otitis is diagnosed in Canada

Ear infections are diagnosed by looking. A doctor or nurse practitioner examines the eardrum with an otoscope, checking its colour, position and whether fluid sits behind it. A bulging eardrum is the most useful single sign of acute otitis media, and pneumatic otoscopy, a small puff of air, shows how well it moves. For otitis externa the canal is examined instead, and if fluid or hearing loss persists, hearing tests and tympanometry follow.

Treatment and day-to-day management

Clinical research for Otitis (inflammation of the ear) is enrolling. See the current studies ↓

Care depends on which part of the ear is affected and how unwell the person is:

• Pain relief, which the Canadian Paediatric Society treats as essential from the start
• Observation with reassessment over 24 to 48 hours for children with mild to moderate illness
• Antibiotics by mouth for children who are highly febrile, moderately to severely unwell, in severe pain, or not improving. Amoxicillin is first-line
• Antibiotic ear drops for otitis externa, applied to the canal rather than swallowed
• Hearing assessment, and referral to consider tympanostomy tubes when infections recur or fluid affects hearing

Which path fits is a decision for you and the clinician who has examined the ear.

When to talk to a doctor

• Redness, swelling or tenderness over the bone behind the ear, a drooping face on one side, a very drowsy child, or a stiff neck with fever needs assessment the same day. Go to an emergency department, or call 911 if the child is seriously unwell.
• The Canadian Paediatric Society advises contacting a doctor if a baby under 6 months may have an ear infection, if fever lasts over 48 hours, if there is redness behind the ear, or if pain persists despite pain medicine.
• Sudden hearing loss in one ear, or severe spinning dizziness, needs prompt assessment at any age.

Why clinical research matters for otitis

Ear infection is one of the commonest reasons a Canadian child sees a doctor, and one of the commonest reasons a child gets an antibiotic, so deciding who needs one matters. Research is aimed at better diagnostic tools, at predicting which children get repeated infections or lasting fluid, and at vaccines covering more of the bacteria involved. Nunavik data points to a second gap: middle ear abnormalities were found in nearly half of five-year-olds screened there.

Clinical studies are how those questions get answered. Taking part is voluntary, informed consent comes first, and you can stop at any time without affecting regular care. No one can say in advance whether a study will help an individual.

Learn more from Canadian sources

• Caring for Kids: ear infections
• Canadian Paediatric Society: acute otitis media
• HealthLink BC: ear infection
• HealthLink BC: swimmer’s ear