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Pus in Ear: Condition, Signs, Treatment, and More

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Ear drops being put into an ear
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Photo by British Columbia Institute of Technology (BCIT), CC BY 4.0, via Wikimedia Commons

The most common cause of pus in ear is otitis media, an infection of the middle ear. The middle ear is the air-filled space behind the eardrum that holds three tiny bones (the ossicles). When germs infect this space, pus can build up behind the eardrum and may drain out if the eardrum bursts.

Infections of the outer ear canal can also cause discharge. Any pus coming from the ear should be checked by a doctor.

Conditions Leading To Pus in Ear

There are certain conditions which can cause discharge from ear:

pus in ear

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  • Acute suppurative otitis media:

This is a middle ear infection caused by pus-forming bacteria. It is most common in young children and often follows a cold or sore throat, when germs travel to the middle ear.

The main route of infection is the Eustachian tube, which connects the middle ear to the back of the nose. Less often, infection enters through a hole in the eardrum from the outer ear.

  • Acute necrotizing otitis media:

This is a rare, severe type of otitis media, mostly in children, that can follow infections such as measles or influenza. It can rapidly destroy the eardrum and parts of the middle ear.

  • Otitis media with effusion:

Also called ‘glue ear,’ this is a buildup of thick or watery fluid in the middle ear without an active infection. The fluid is not pus. It is much more common in young children.

The main symptom is temporary hearing loss. The NHS says glue ear usually clears up on its own within 3 months, but see a doctor about any hearing problems.

  • Chronic suppurative otitis media:

Chronic suppurative otitis media (CSOM) is a long-lasting middle ear infection with a hole in the eardrum and repeated or ongoing discharge. It usually develops when an acute infection does not fully heal.

Doctors traditionally describe two types. The tubotympanic (mucosal) type is generally less serious, while the atticoantral (squamous) type is linked with cholesteatoma and a higher risk of complications.

  • Tubercular otitis media:

This rare infection usually occurs alongside tuberculosis elsewhere in the body, often the lungs. It develops slowly and can cause several holes in the eardrum. The discharge is often painless.

What Are The Signs And Symptoms Of Pus In Ear?

The most common sign of a middle ear infection is ear pain (otalgia). Other signs may include

  • Fever
  • Discharge of pus or fluid from the ear, often after the eardrum bursts
  • A feeling of pressure or fullness in the ear
  • Pain while lying down
  • Ringing or buzzing in the ear
  • Hearing loss
  • In babies and young children: pulling at the ear, irritability, poor feeding or trouble sleeping

What Causes Recurrent Pus in Ear?

Children: Recurrent ear infections are most common in children between about 6 months and 6 years old. Doctors may consider ear tubes when a child has 3 or more ear infections in 6 months, or more than 4 in a year.

Risk factors include day care, exposure to tobacco smoke, pacifier use and not being breastfed. MedlinePlus notes that drinking from a bottle or sippy cup while lying on the back may let milk enter the Eustachian tube and raise the risk.

Adults: In adults, recurrent infections may be linked to sinus problems, allergies, enlarged adenoids or tonsils, smoking or a weakened immune system.

How Long Pus In Ear Last?

The NHS says most ear infections clear up within 3 days, though symptoms can last up to a week. Some infections last longer and need treatment.

Chronic infections can continue for weeks or months despite treatment, and some need surgery.

How Can Doctor Diagnose You?

Your doctor will ask about your history and examine your ears. Tests may include

  • Otoscope (an instrument to see eardrum)
  • Audiometry, to see hearing loss
  • Tympanometry (impedance audiometry), which checks how the eardrum moves and can show fluid behind it, useful in infants and children
  • Tuning fork tests and vibration tests to check your hearing loss
  • Culture and sensitivity of ear discharge
  • CT scan of the mastoid bone (behind the ear) if a deeper infection or cholesteatoma is suspected

What Are The Predisposing Conditions Of Pus In Ear?

Anything that interferes with the normal function of the Eustachian tube makes a middle ear infection more likely. This includes

  • Colds, flu, measles and other respiratory infections
  • Infected or enlarged tonsils and adenoids
  • Chronic rhinitis
  • Nasal allergy
  • Tumors of the nose or throat (rare)
  • Cleft palate

What Treatment Options Do You Have?

  • Antibiotics: Many ear infections clear without antibiotics, so doctors may suggest waiting a few days. Antibiotic tablets or ear drops may be prescribed for bacterial infections, severe symptoms, infections in young babies or discharge through a perforated eardrum. Take the full course as prescribed.
  • Decongestants and antihistamines: The NHS says there is no evidence these help with ear infections, so they are not routinely recommended.
  • Pain and fever relief: Acetaminophen (paracetamol) or ibuprofen can ease pain and fever. Children and teenagers should not take aspirin.
  • Ear cleaning: A doctor may gently clean discharge from the ear canal (aural toilet) so that prescribed drops can work.
  • Warmth: A warm cloth held against the outside of the ear may help relieve pain.
  • Myringotomy and ear tubes: A small cut in the eardrum lets fluid drain, often with a tiny tube left in place. It may be used for repeated infections or for fluid that lasts more than about 3 months and affects hearing.
  • Mastoidectomy: Surgery to remove infected bone and tissue from the mastoid bone behind the ear, used for serious or chronic infections and cholesteatoma.

Don't put oils, peroxide or home remedies in an ear that is draining pus, as the eardrum may have a hole in it.

What Are Sequelae Of Pus In Ear?

Persistent or repeated infection in the ear can cause

  • Eardrum rupture
  • Ear bones destruction
  • Fixation of ear bones
  • Retraction pockets in ear
  • Damage and stiffening of the joints between the ear bones
  • Hearing loss
  • Tinnitus (buzzing in the ear)
  • Vertigo (dizziness)

When to See Doctor?

See a doctor promptly if pus or fluid is coming out of your ear. The NHS also advises urgent help for an ear infection with high fever, swelling around the ear, new hearing loss, vomiting or dizziness, or in a baby under 12 months.

Get emergency care for severe headache, stiff neck, confusion, facial weakness, or redness and swelling behind the ear. Treating infections early helps protect your hearing.

HP Thoughts: Read about another incidence of ear pus here: Pus from Ear.

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