Ear Pain in Bangkok: Outer Ear, Middle Ear and Pressure Problems
How Doctor Bangkok diagnoses the three common causes of ear pain and treats each correctly.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician, Doctor Bangkok
Ear pain has three common causes that need different treatment: outer ear infection (otitis externa, swimmer’s ear), middle ear infection (otitis media), and ear pressure problems from flight or diving (barotrauma). At Doctor Bangkok we examine with an otoscope, decide the diagnosis in 5 minutes, and treat with the right medication: topical antibiotic drops for otitis externa, oral antibiotics only when indicated for otitis media, and decongestants plus pressure management for barotrauma.
From the clinic: Ear pain is a frequent tourist complaint in Bangkok because of the combination of humidity, swimming, flying, and swimming lessons gone wrong. The wrong diagnosis is the main source of suffering: oral antibiotics do not treat swimmer’s ear, and ear drops do not treat middle ear infection when the eardrum is intact. An otoscope in the first minute of the visit answers the question, and the rest follows. The exception is severe pain in a patient who is also unwell, which raises the possibility of complications and changes the plan.
Outer ear infection (otitis externa)
Swimmer’s ear is infection of the ear canal, usually bacterial (Pseudomonas, Staphylococcus), sometimes fungal. Pain is worse when the tragus or pinna is moved, the canal is red and swollen, and there may be discharge. Treatment is topical antibiotic drops (often with a corticosteroid) for 7 days, keeping the ear dry, and simple analgesia. Oral antibiotics are not needed unless there is cellulitis beyond the ear or the patient is immunocompromised. Our page on swimmer’s ear covers the full treatment.
| Outer ear (otitis externa) | Middle ear (otitis media) |
|---|---|
| Recent swimming | Recent cold or URI |
| Pain on touching ear | Deep ear pain |
| Visible canal inflammation | Red bulging eardrum |
| Discharge from canal | Hearing loss, fever |
| Topical antibiotic drops | Oral antibiotics when indicated |
| Keep ear dry | Decongestants, analgesia |
Middle ear infection (otitis media)
Middle ear infection is inflammation behind the eardrum, usually following a viral upper respiratory infection. Pain is deep in the ear, often with fever and hearing loss. In children, tugging at the ear and irritability are common. The eardrum appears red, bulging, and may have fluid behind it. Most cases in older children and adults resolve without antibiotics in 2 to 3 days; delayed prescribing (a prescription to use only if no improvement at 48 hours) is often appropriate. Antibiotics are indicated for severe cases, bilateral infection in young children, symptoms beyond 2 to 3 days, or any sign of complications. Amoxicillin is first line.
Ear pressure problems from flight or diving
Barotrauma is pressure damage to the middle ear from rapid altitude or depth change without pressure equalisation. It causes pain, fullness, muffled hearing, and sometimes a small bleed into the middle ear visible on examination. Treatment is decongestants, analgesia, and pressure equalisation techniques (Valsalva, chewing, swallowing). Most cases resolve within days. Severe cases with perforation of the eardrum need review and avoidance of swimming until healing. Divers should not dive with a cold or any congestion and should equalise early during descent. Our page on upper respiratory infection covers viral illness that predisposes to barotrauma.
When to see a doctor
Book same-day for severe ear pain, ear pain with fever, ear pain with discharge, ear pain after diving or flying that is not settling, hearing loss, or dizziness. Seek emergency care for severe ear pain with facial weakness, severe swelling behind the ear, high fever with neck stiffness, or any suggestion of complications like mastoiditis or intracranial spread. Any ear pain in an immunocompromised patient (particularly diabetic elderly) deserves urgent review because of the rare but serious possibility of malignant otitis externa.
Red flag: If red-flag symptoms appear, do not wait. Book same-day or present to the nearest emergency department as described above.
Prevention and early detection
Keep ears dry after swimming by tilting the head and gently drying with a towel. Do not use cotton buds, which push wax deeper and damage the canal. Patients with recurrent swimmer’s ear can use acetic acid or alcohol-based ear drops after swimming as prophylaxis. Treat upper respiratory infections early and avoid flying with a cold where possible. Divers should not dive with congestion and should equalise regularly during descent. Keep ear wax under control with drops or professional removal rather than attempting home extraction with sharp objects.
Summary
Ear pain is one of those problems where a quick look with an otoscope saves everyone time. The three common causes need three different treatments, and using the wrong one wastes days. As Dr. Pitsuwan puts it: “The examination is the diagnosis in ear pain. Once you see the canal and the eardrum, the treatment writes itself.” Doctor Bangkok does same-day otoscopy and treatment from our Sukhumvit clinic.
Frequently asked questions
How do I know if it is outer or middle ear?
Outer ear pain is worse when the pinna or tragus is moved and the canal is often visibly inflamed. Middle ear pain is deep, often with fever, and the examination shows a red bulging eardrum.
Will antibiotics help my ear infection?
It depends. Topical drops for outer ear, oral antibiotics only when indicated for middle ear, no antibiotic for pressure problems. Wrong antibiotic does not help.
Can I fly with an ear infection?
Flying with severe ear pain or eardrum perforation is best avoided. Mild middle ear fluid with intact eardrum can usually tolerate flight with decongestants and careful equalisation.
How long does swimmer’s ear take to clear?
Most cases improve within 48 to 72 hours of starting the right ear drops, with full resolution in 7 to 10 days. Keeping the ear dry matters.
What if I have discharge from my ear?
Discharge suggests either outer ear infection, perforated middle ear drum, or other pathology. All deserve examination to confirm the source and guide treatment.
Can I clean my ears at home?
Yes, gently with a cloth on the outer ear. Do not use cotton buds, candles, or sharp objects inside the ear canal. Ear wax needing removal is a clinic procedure.
Sources
- American Academy of Otolaryngology-Head and Neck Surgery. Otitis externa and otitis media guidelines. aao-hnsf.org.
- NICE. Otitis media and otitis externa: antimicrobial prescribing. nice.org.uk.
Ear pain Bangkok, otalgia, otitis externa, swimmer’s ear, otitis media, acute otitis media, barotrauma, Eustachian tube dysfunction, ear canal infection, tympanic membrane, eardrum perforation, mastoiditis, malignant otitis externa, topical antibiotic ear drops, ciprofloxacin drops, hydrocortisone drops, amoxicillin, otoscope examination, decongestant, Valsalva manoeuvre, AAO-HNS guideline, NICE otitis guidance, Dr. Ponlawat Pitsuwan, Doctor Bangkok.