Infection can enter the ear from the outside via dirty swimming pools or the surf, and also by picking at the ears with dirty fingers: external ear infection.

In the case of the middle ear, bacteria or viruses travel up from the nose and mouth to cause inflammation behind the ear drum and the resulting earache can be much more intense than that associated with outer ear infection.

Otitis externa or inflammation of the outer ear is generally due to a mixed bacterial and fungus infection with an uncomfortable rather than painful ear. It is often called swimmers ear and can be prevented to a reasonable degree by wearing a bathing cap or earplugs. the use of drops inserted after thoroughly drying the ear after exposure to water may also help.

Treatment consists of carefully cleaning out the ears, which may have to be a doctor, and the use of local antibiotic and antifungal drops.

Otitis media or inflammation of the middle ear produces more severe earache as the pressure builds in the middle ear. Otitis media can produce an abscess which, on bursting through the ear drum, causes a dramatic lessening in the intensity of the pain and a yellow discharge of pus from the ear. the infection should nor be allowed to get to this stage. Prompt, early treatment will prevent these complications. Other complications include perforation of the ear drum and also infection of the mastoid bone behind the ear and finally in extreme cases meningitis.

Treatment of middle ear infection consists of bed rest, pain killers (paracetamol. not aspirin in children) , and antibiotics. Nasal sprays or drops help clear the nose and may allow for drainage of the middle ear. Keeping the ear warm may be a help in the early stages.

Surgical incision of the ear drum to allow for drainage of the middle ear may be necessary. To prevent complications it is important to see your doctor if an earache lasts for more than a day or two, or is particularly severe.