Definition - What is pus in the ear?

Pus - also referred to in medicine as pus - arises mainly in bacterial infections of the ear, but can of course also at any other infected body site (such as skin or wounds) occur.

With some bacteria it comes to particularly strong pus formation. Pus consists mainly of proteins and disintegrated tissue. The tissue breakdown is caused by enzymes of the bacteria and by the white blood cells such as granulocytes. The white blood cells and the bacteria - both alive and killed - are therefore also in the pus. Usually pus has a whitish-yellow color. In some cases, a little blood may be added.

CAUSES of pus in the ear

In the ear different parts can be infected and thus origin of the pus in the ear.

  • This can lead to inflammation of the external auditory canal (otitis externa). This often leads to visible pus.
  • On the other hand, an infection of the middle ear (otitis media) can lead to pus formation and cause suppuration of the ear with additional injury to the eardrum.
  • Inner ear infection (labyrinthitis), which can also develop from a middle ear infection, is often associated with pus formation.
  • Even infected injuries or foreign bodies can be the cause of a purulent infection.
  • Another cause of pus may be pimples or purulent bumps (abscess).

The inflammation of the ear, where it comes to pus formation, are caused in most cases by bacteria. If the infection is triggered by viruses or fungi, pus formation only occurs if, in the course of the disease, superinfection with bacteria is added.


A purulent middle ear infection occurs especially in the winter months. It usually arises from an ascending infection of the upper respiratory tract. Therefore, mainly children are affected because the mouth-ear connection (Eustachian tube or Tuba auditiva) is shorter. Common causes of otitis media are common viral and bacterial mixed infections.

If there is a bacterial infection, pus formation may also occur in the middle ear. The discharge of pus from the ear occurs when the eardrum tears or the inflammation spreads to the external auditory canal. The tear in the eardrum grows in most cases within 1-2 weeks again.

Accompanying SYMPTOMS

During a middle ear inflammation it can come to general symptoms of illness such as fever and exhaustion. Often a reduced hearing and dizziness is noticeable. The general condition is also severely impaired in most cases. The common pain in the ear can also radiate and cause headaches.

If the tympanic membrane tears, it can lead to otorrhea. This means that pus visibly flows out of the ear. Since otitis media is often caused by ascending infections of the ear, nose and throat, dysphagia, sore throat or runny nose can occur or precede. An inflammation of the external auditory canal causes pressure pain on the ear. Here, too, the swelling of the ear canal can lead to deafness. If a foreign body enters the ear and clogs the ear canal, it can lead to hearing loss on the affected side.

With Pain

Pain in the ear or in the area of ​​the ear speak for an ear disease. Especially in the middle and outer area, the ear is sensitive. Very severe and stinging earache often occurs in middle ear infection. In adulthood and adolescence, inflammation of the external auditory canal is more common. The cause is often too frequent cleaning of the ear canal with ear buds. These irritate the mucous membrane of the ear. This irritation may cause unpleasant pain and pus formation.

Furthermore, an ear herpes (zoster oticus) leads to a blistering on the ear or in the ear canal to severe pain. This also leads to a secretion of the blisters, which may be visible in or on the ear. However, this fluid is not pus but a clear vesicular fluid, which, however, appear yellowish with earwax and can mimic pus.

Without pain

On the one hand, chronic otitis media may be associated with no pain but with pus formation. In some cases, sufferers have also "got used" to the pain and no longer perceive it as such. The secretion that flows from the middle ear into the external auditory canal is usually creamy-yellow or slimy. It can smell bad or odorless. Chronic otitis media may also be associated with hearing loss, dizziness and tinnitus.

On the other hand, pus flow from the ear without pain can be a tympanic effusion (seromukotympanum). This is due to a ventilation disorder in the ear to a secretion collection in the tympanic cavity. If it comes to an infection and pus formation of the secretion, it is often pain. The tympanic effusion is accompanied by a feeling of pressure in the ear and deafness. In adults, a further diagnosis should necessarily be made, since in addition to colds, throat infections and sinus infections, nasopharyngeal carcinoma may be responsible for the aeration disorder.

With difficulty swallowing

Pharyngitis or tonsillitis (tonsillitis) may also spread to the ears and cause otitis media there. Especially when bacteria such as streptococci have triggered the inflammation in the throat, a purulent otitis media may follow. Acute tonsillitis can cause sore throat and pain as well as sore throat. It may also come to a kloßigen language and bad breath (foetor ex ore). Especially schoolchildren are affected by tonsillar tears. However, it can generally occur at any age.

Pus runs out of the ear - What is behind it?

An inflammation of the ear may be accompanied by a secretion of pus from the ear (otorrhea).

  • In most cases, the inflammation is directly in the ear canal. This often occurs when the ear canal is manipulated (for example, by frequent cleaning with ear buds).
  • Sometimes, however, there is also tearing of the eardrum by a purulent inflammation in the middle ear. In part, the pus may also be spiked with blood. Partly it comes to a stinking pus outflow (fetid Otorrhoe). This typically occurs in an infection with the bacterium Pseudomonas aeruginosa.

In any case, it should emanate from pus discharge from a pathological event in the ear. Pain is almost always present. If an otorrhea is diagnosed, an ENT specialist should be consulted, which will investigate the cause.


Pus in the ear hole

Pus in the ear hole often occurs after piercing an ear hole for earrings. Since it comes here by piercing the ear tissue to a "wound", this can also be infected by the ingress of bacteria and fester. These can get into the open tissue either by uncleaned material during piercing or afterwards.

In addition, it usually comes to pain, redness and swelling of the ear. The earring should urgently be removed when suppurating the ear hole to prevent further irritation of the ear. It should then be done daily with disinfectant solutions. If fever occurs in addition to pus, antibiotics should be taken in the form of tablets.

Pus behind the ear

In harmless cases, pus behind the ear is a pus-filled or scratched pimple.

However, it may also be an inflammation of the behind the ear mastoid (mastoid process) act. This is the noticeable protruding bone behind the ear. In addition to pus formation can cause severe ear pain, swelling, redness and overheating of the mastoid. Since this is a dangerous condition with complications such as hearing loss, meningitis or brain abscess, the treatment should be in the hospital. In addition to pain therapy, an intravenous (administered directly into the vein) antibiotics should be done. If the symptoms do not improve within the first two days or a large purulent epithelium (abscess) becomes visible, surgical treatment should be performed with removal or removal of the mastoid.

DIAGNOSIS of a purulent ear

The doctor arrives at the diagnosis by asking a questioning of symptoms and course at the beginning. This is followed by a physical examination, looking into the oral cavity and the ears, scanning lymph nodes and listening to lungs.

The examination of the ear is carried out by means of an otoscope. With the otoscope you can assess the ear canal and the eardrum and thus find out where the infection comes from. If it is a middle ear infection, you often see a red, bulging eardrum. If the tympanic membrane tears, pus drops may be seen on the eardrum. In an external auditory canal inflammation pus is found in the ear canal.

THERAPY OF A purulent ear

  • A middle ear infection is mainly treated symptomatically. This means that the patient should drink a lot to dilute the formed mucus. In addition, the use of decongestant nose drops is important to restore the ventilation in the ear. Treatment for the pain is usually done with paracetamol or ibuprofen.
  • Pus formation in the ear is usually bacterial infections, which must be treated with oral antibiotics. In case of an otitis externa, the ear canal should be cleaned. When pus formation, antibiotics should be applied to the ear canal to treat the bacterial infection.
  • If the inflammation is triggered by the penetration of a foreign body, it must first be removed.
  • If a tympanic effusion is responsible for the formation of pus, antibiotics should also be given here. If it does not come to the outflow of the secretion, is the insertion of a tympanic tube in the eardrum.

Do you have any further interest in this topic? Read more about: Treatment with antibiotics

Which home remedies can help?

There are several home remedies used for middle ear infections. On the one hand, a so-called onion compress (chopped onion in a linen cloth) can be placed on the ear. The onion has an antibacterial effect. Camomile also has an anti-inflammatory effect. For example, a bag of chamomile tea can be infused. The tea is drunk, the bag is expressed and placed on the affected ear. The tea can thus also be effective in bacterial infections of the external auditory canal. Heat can relieve the pain of middle ear infection and aid healing. This can be applied by means of a red light lamp or, for example, by warm potato raking in a linen cloth.

When do I need antibiotics?

Since pus in the ear usually speaks for a bacterial cause, antibiotics should always be used. In an external auditory canal inflammation, the antibiotic is usually applied directly into the ear canal.

If the person has a strong weakening of the immune system (for example due to a disease such as HIV) or an existing diabetes mellitus (Diabetes mellitus) antibiotic therapy should be in tablet form.

In a middle ear infection - which is usually caused by viruses - pus also indicates a bacterial event. Further evidence of a bacterial ear infection is a strong feeling of illness with a high fever, pus discharge from the ear and lack of improvement of the symptoms within the first 2 days. Then an antibiotic treatment should be done.

Which are the best antibiotics?

Which antibiotic is used depends on the bacterium that causes the infection. The structure of the bacteria is different. For example, there are differences in the structure of the bacterial wall. Since antibiotics have different targets, certain antibiotics only work for certain bacteria.

  • Otitis media is often Streptococcus pneumoniae or Haemophilus influenzae. The antibiotic of choice is the so-called amoxicillin.
  • If the external auditory canal is affected, another bacterium is often responsible for the infection: it is often a Pseudomonas aeruginosa infection. Antibiotics of the group of quinolones (eg ciprofloxacin) are then used.

In any case, especially if there is no improvement in symptoms after taking the antibiotic, there should be a swab of the ear. Here, the infection causing bacterium is determined safely. At the same time, a so-called antibiogram is made, whereby it is apparent which antibiotic is effective against the bacterium.

DURATION of the healing process

Since the formation of pus in the ear can have different causes, the duration of the disease is different. However, with the right treatment, it should come to a cure within one to two weeks.

If a middle ear infection occurs longer or returns at certain intervals, it is a chronic inflammation. This is usually the eardrum damaged. This facilitates inflammation of the ear. The treatment is then carried out by restoring the eardrum (tympanoplasty). In most cases, then it comes to a cure. In part, however, despite tympanoplasty recurring inflammations are recorded, which must be treated again and again.

How contagious is pus in the ear?

In the pus are beside dead bacteria also living ones. Therefore, the pus in the ear is also contagious.

The infection can arise, for example, by hand contact with the pus. However, this does not have to be an infection of the ear, but can also cause infections of the pharynx, respiratory tract or the skin. In turn, how much bacteria is needed to cause an infection depends on the type of bacteria and their ability to cause disease in the body (virulence). In addition, the particular strength of the immune system of humans plays a role, whether an infection can easily or with difficulty.

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