Acute and chronic ear infections, hearing disorders and balance disorders can occur in adults and in children. This page covers the common ear infections, hearing disorders and balance conditions we see at the practice.
Common ear infections and conditions
Acute otitis media (middle-ear infection)
Acute otitis media is an infection behind the eardrum that causes pain, fever and fluid build-up. It is particularly common in children but can affect adults.
It’s often caused by bacteria or viruses and frequently starts with a cold. The middle ear is connected to the back of the nose by the Eustachian tube, which can become inflamed and congested — impairing ventilation of the middle ear and allowing infection to set in.
Symptoms include earache, fever, difficulty hearing, headache and impaired balance. There may be discharge from the ear if the eardrum is inflamed or has ruptured.
Middle-ear infections usually resolve within a week. Over-the-counter pain medication is often enough; antibiotics are occasionally required for complicated infections. Recurrent infections in children may warrant surgical intervention such as grommet insertion.
Otitis media with effusion (glue ear)
Glue ear is a common condition that mostly affects children but can also occur in adults. Sticky fluid builds up in the middle ear, causing hearing loss and a blocked-ear sensation. It often follows a cold or ear infection; allergies and exposure to cigarette smoke can also contribute. Glue ear often clears on its own but can persist for weeks or months.
Symptoms aren’t always obvious. Watch for:
- Feeling of pressure or fullness in the ear
- Mild ear pain
- Trouble hearing
- Balance issues
- Trouble sleeping
Children may also be irritable, struggle to pay attention, talk loudly, rub or pull at their ears, or show delayed speech and language development. If glue ear persists longer than 2–3 months, grommet insertion may be considered.
Chronic suppurative otitis media
A persistent, long-standing middle-ear infection marked by a perforated eardrum, ongoing ear discharge (otorrhoea) lasting 2–12 weeks or more, and associated pain or fever. It’s usually caused by bacterial infection and can develop after untreated acute infections.
Otitis externa
A common bacterial or fungal infection of the outer ear. Causes include trauma (cotton-bud use, scratching), ear-canal obstructions, environmental factors (humidity, swimming) or underlying skin conditions. When linked to swimming, it’s known as “swimmer’s ear”. Symptoms include intense ear pain, muffled hearing, itchiness and discharge. Treatment usually involves appropriate ear cleaning and prescription antibiotic eardrops, with symptoms improving within a few days.
Eustachian tube dysfunction (ETD)
Eustachian tube dysfunction occurs when the tubes connecting the middle ears to the back of the nose become blocked. These tubes equalise middle-ear pressure with atmospheric pressure, which helps prevent infection. ETD commonly follows colds or flu, allergies or chronic acid reflux. It can affect anyone, but is more common in children — partly because of large adenoids.
Symptoms include ear pressure or pain, clicking or popping sounds, a feeling of fullness, tinnitus, dizziness and hearing loss. ETD often resolves on its own, but persistent symptoms (more than two weeks) may need over-the-counter or prescription medication.
Cholesteatoma
An abnormal growth in the middle ear, behind the eardrum, typically associated with chronic Eustachian tube dysfunction. It can also be present from birth. It develops when dead skin cells collect behind the eardrum to form a lump or cyst.
The most common symptom is smelly discharge from the ear, but it can also cause pain, hearing loss and dizziness. The only way to remove a cholesteatoma is through surgery.
Perforated eardrum
A perforated (or ruptured) eardrum is a hole or tear in the thin tissue between the ear canal and the middle ear. Causes include severe head trauma, placing objects in the ear, loud sounds or blasts, middle-ear infections, or barotrauma (air-pressure stress on the ear).
A perforation can cause hearing loss and increase the risk of middle-ear infections. Symptoms may include ear pain (that often resolves quickly), hearing loss, fluid leaking from the ear, tinnitus, vertigo or nausea. Most perforations heal on their own within a few weeks; more severe or persistent perforations may require surgical repair.
Hearing loss types and causes
Conductive hearing loss (CHL)
Conductive hearing loss occurs when sound waves can’t reach your cochlea — the hearing sense organ of the inner ear. Causes include ear infections, blockages or structural issues. Symptoms can include:
- Muffled hearing
- Fullness in the ear
- Sudden or steady loss of hearing
- Pain or tenderness in the ear
Diagnosis often requires a hearing test (audiogram) performed by an audiologist or trained nurse. People with conductive hearing loss should see an ENT specialist for diagnosis and to discuss treatment — including surgical options where relevant.
Sensorineural hearing loss (SNHL)
SNHL occurs when sound can’t be appropriately conducted to the brain by the inner ear (cochlea). It can be present at birth or develop later, suddenly or gradually. It is the most common form of permanent hearing loss. Causes include ageing, genetic factors, loud noise exposure and — rarely — tumours.
People with SNHL may find it difficult to hear in loud environments, experience tinnitus, struggle to follow conversations and generally feel their hearing is muffled. While SNHL cannot be cured, it can be managed with hearing aids, cochlear implants or medications (if SNHL is caused by disease or inflammation).
Age-related hearing loss (presbycusis)
Age is the most common reason people lose hearing. People with presbycusis may find it harder to follow conversations and increase audio volumes. There is no cure, but it can be managed with hearing aids or cochlear implants.
Otosclerosis
Otosclerosis occurs when an abnormal bone process in the middle or inner ear stiffens the conductive pathway and interferes with sound transmission. It usually starts slowly and worsens over time. It often begins in early adulthood, is more common in women, and may worsen during pregnancy. Otosclerosis is the most common cause of middle-ear hearing loss in adults.
The most common symptom is hearing loss. The exact cause is unknown, but contributing factors may include genetics, infections, inflammation, autoimmunity and hormones. Treatment depends on the type and severity of hearing loss — and may include hearing aids, surgery or medications.
Tinnitus (ringing in the ears)
Tinnitus is hearing ringing or other sounds in your ears despite there being no external sound. It can come and go, or be constant. Some people find it manageable; others find it very distressing. It is often perceived as a constant, high-pitched ringing or pulsing sensation, but can take many forms.
Causes include exposure to loud noise, hearing loss, infections or inflammation, inner-ear problems, or vascular issues near the ear. Other health problems can contribute, and often the cause is unclear. Treatment depends on the cause and impact. If tinnitus is a concern, ask your GP for a referral to an ENT specialist for further testing.
Dizziness and balance disorders
Dizziness and balance disorders often stem from inner-ear disturbances — and are usually manageable. They can also stem from neurological conditions, cardiovascular issues, or medication side effects.
Common inner-ear causes include vestibular migraine, benign paroxysmal positional vertigo (BPPV) and vestibular neuritis (inflammation of the inner-ear balance apparatus). Treatment depends on the diagnosis and severity — balance testing may be needed, and vestibular (balance) physiotherapy is often very effective.
Ménière’s disease
Ménière’s disease is a chronic disorder of the inner ear that can affect balance and hearing. It usually affects adults, with vertigo (spinning) as the main symptom — accompanied by hearing loss, tinnitus and a feeling of fullness in the ear during acute episodes. It usually affects only one ear and can cause hearing loss in that ear.
The cause is unknown but is thought to relate to excessive fluid build-up in the inner ear (endolymph). While chronic, the disease is manageable — most patients experience relief through lifestyle changes and medication. Inner-ear injections or surgery are rarely required.
Labyrinthitis and vestibular neuritis
These disorders cause inflammation of the inner ear and the nerve connecting it to the brain. They are most commonly caused by viral infections.
Vestibular neuritis brings the sudden onset of constant, intense spinning that is usually disabling and requires bed rest. Nausea, vomiting and visual difficulty are common. Labyrinthitis also affects the inner ear or cochlear nerve, causing hearing loss or tinnitus. Vestibular neuritis can be treated with corticosteroids and, if needed, medication to reduce nausea and vertigo. Treatment for labyrinthitis depends on the cause.
How are ear and hearing conditions diagnosed?
Ear and hearing conditions are usually diagnosed through a combination of medical history review, physical examination and specialised hearing tests.
When should you see an ENT surgeon?
If you’re concerned about an ear infection or hearing problem, see your GP first. They’ll assess you and, if appropriate, provide a referral to Dr Padhye.
