Inflammation of the middle ear

Inflammation of the middle ear may be caused by a number of conditions. The inflammation normally leads to fluid collection (effusion) and hearing loss. The condition is described as chronic when it lasts more than three months and doesn’t respond to treatment by drugs.

Many causes of inflammation of the middle ear (such as otitis media) clear up on their own within a few days and don't require any specific treatment.
However if the condition becomes chronic (i.e. doesn’t go away or keeps recurring) then it may require treatment. Any infection, fluid or swelling behind the eardrum can result in long-term or permanent damage to the ear.

There are a number of specific conditions that may lead to inflammation of the middle ear, each with a range of causes.

Otitis media is a group of inflammatory viral and bacterial diseases of the middle ear. The two main types are otitis media with effusion (OME) andacute otitis media (AOM). AOM is a rapidly developing infection that usually producers sever ear pain.

Cholesteatoma (a type of skin cyst in the middle ear) can be the result of a birth defect (congenital) or, more commonly, it is caused by a chronic ear infection. The cyst may become infected or enlarge, which may affect hearing, balance, and sometimes the way your facial muscles work.

Mastoiditis is an infection of the mastoid bone in the inner ear, usually caused by an infection of the middle ear spreading into the surrounding bone (the mastoid process).

Chronic Suppurative Otitis Media (CSOM), a disease of the middle ear, is an ongoing cycle of infection causing inflammation, ulceration, and granulation. This may result in damage of the surrounding structures.

The exact cause of eosinophilic otitis media is unknown, but it is thought to be associated with bronchial asthma and nasal allergy. It can sometimes lead to hearing loss.

Inflammation of the middle ear can cause a variety of symptoms. Symptoms including hearing loss, pain, pressure or fluid in the ear may affect one or both ears and may be constant or come and go.

A range of symptoms may be present depending on the exact condition causing the inflammation. These include fever and a persistent, throbbing pain around and within the ear. There may be a minor or profuse discharge of fluid from the ear - this may be fluid, pus or a bloody discharge. Hearing may be impaired and this may well get suddenly worse or progressively worse as the condition progresses. Some patients will experience a fever and perhaps dizziness or balance impairment.

We recommend that you contact your doctor as soon as possible if you are experiencing any of these symptoms, or if you suspect your eardrum may be perforated.

  • mild ear pain
  • pressure in the ear
  • fluid build-up, or fluid draining from the affected ear
  • fever
  • hearing loss
  • impaired balance
  • confusion or sleepiness
  • facial weakness
  • difficulty sleeping


Your doctor will initially assess your condition and may need to refer you to a specialist for additional tests and diagnosis.

A visual examination will be required using a medical device (otoscope or auriscope) to look into your ears. If you have a discharge from your ears a sample may be taken for testing and diagnosis.

Further tests may also be required. For example, if cholesteatoma is suspected, computed tomography (a CT scan) or magnetic resonance imaging (an MRI scan) may be suggested.

MRI scan

MRI (magnetic resonance imaging) is a special technique that uses powerful magnets, radio waves and computers to produce detailed images (or scans) of the inside of your body.

CT scan

CT stands for ‘computerised tomography’. A CT scan is a detailed X-ray used to create detailed images of the inside of your body.   

What next?

If you are suffering with a suspected condition, you should seek the advice of your doctor who will be able to refer you to Benenden Hospital for diagnosis and treatment.

There are four ways to access treatment at Benenden Hospital which include self-funding, using private medical insurance or your Benenden membership, or through the NHS e-Referral scheme.