When to see a vet urgently
The following changes accompanying ear symptoms need prompt veterinary assessment:
- Your cat falls, circles or cannot walk normally.
- A head tilt develops suddenly and the eyes move involuntarily back and forth.
- The face looks asymmetrical or your cat cannot blink one eye.
- Nausea or balance difficulties prevent eating or drinking.
Contact the practice immediately. You can find a vet near you.
Overview
The middle ear lies between the eardrum and inner ear. It is important for transmitting sound and equalising pressure. Inflammation can cause fluid or pus to collect in the bulla, producing pain, reduced hearing and a risk of infection spreading to the inner ear or brain.
The tympanic bulla is the bony middle ear cavity within the skull. It differs from the ear flap and the ear canal opening to the outside. The auditory tube connects the middle ear to the nasopharynx, so microbes can also reach it from the throat.
The small middle ear bones transmit eardrum vibrations to the inner ear. The inner ear contains both the cochlea, involved in hearing, and the balance organ. This anatomy explains why deep ear disease can change both hearing and movement. A clean-looking outer ear does not alone show what is happening behind the eardrum.
Causes
Common causes of middle ear disease include:
- complications of bacterial or parasitic outer ear inflammation;
- upper respiratory infections, including rhinotracheitis and calicivirus;
- bacteria reaching the middle ear through the Eustachian tube;
- injuries to the ear or eardrum;
- growths, including polyps and tumours of the nasopharynx or ear canal;
- foreign bodies.
The polyps listed are inflammatory growths arising from the lining rather than malignant tumours. They can grow from the middle ear into the ear canal or towards the nasopharynx and sustain inflammation. Location affects whether your cat shows ear symptoms or, for example, noisy breathing, sneezing and difficulty swallowing.
A link between respiratory infection and ear disease does not mean that the viruses mentioned have been shown to cause every ear problem. The precise origin of inflammatory polyps in particular is unknown, and a clear association with herpesvirus or calicivirus has not been confirmed.
Risk factors
Middle ear infections occur more often in cats that:
- have chronic ear infections;
- have weakened immune defences;
- belong to brachycephalic breeds with particular nasopharyngeal anatomy;
- live in damp or dusty surroundings;
- are older.
Information on risk factors for feline middle ear disease is limited. The significance of a damp or dusty environment, for example, is not established by this list. Age does not restrict disease to older cats either: inflammatory polyps occur particularly in young cats and have no clear known breed predisposition. Repeatedly recurring ear symptoms warrant investigation at any age.
Main symptoms
Middle ear disease may cause:
- a head tilt towards the affected ear;
- frequent head shaking or ear scratching;
- pain when the head is touched;
- ear discharge containing pus or mucus;
- reduced hearing;
- balance problems, including an unstable gait or circling;
- listlessness and loss of appetite.
Balance problems often suggest involvement of the inner ear balance organ or another part of the vestibular system. They are not a definite sign of middle ear inflammation alone. Other neurological diseases, a medicine's adverse effects or an unexplained vestibular disorder can cause similar signs. Sudden falling should therefore not be diagnosed as an ear infection at home.
Disruption of nerves passing near the middle ear can cause a smaller pupil, drooping upper eyelid or visible third eyelid. This combination is called Horner's syndrome. Impaired facial nerve function can make closing the eye or keeping food in the mouth difficult. Opening the mouth may also hurt even without visible ear discharge.
Complications and consequences
Without treatment, middle ear inflammation can lead to:
- infection spreading to the inner ear, causing labyrinthitis;
- perforation of the eardrum;
- hearing loss;
- neurological problems, including facial nerve damage and vestibular disorders;
- abscesses and meningitis.
Serious infections spreading to the central nervous system are possible, but are not the usual consequence of every ear infection. Recovery from hearing and nerve damage varies. Some changes may remain permanent even after inflammation is treated. A clear decline in general condition, fever or altered consciousness also warrants assessment for more extensive disease.
Diagnosis at the vet
Investigations used to make a diagnosis include:
- otoscopy to examine the ear canal and eardrum;
- X-rays or CT of the temporal bone region;
- ultrasound and nasopharyngeal endoscopy if a polyp is suspected;
- analysis of ear discharge, including bacteriology and cytology.
The eardrum may be intact and look normal despite inflammation behind it. Canal narrowing, pain and discharge can also prevent a clear view. Sedation or general anaesthesia may be needed for examination and sampling. Both ears are assessed even if you noticed symptoms on only one side.
CT, or computed tomography, and MRI detect middle ear changes more sensitively than routine X-rays. They look for fluid, tissue masses or bone changes, for example. The ultrasound mentioned above does not replace these deep ear investigations. Suspected polyps also prompt examination of the nasopharynx, and removed tissue may be examined microscopically.
Bacterial culture helps choose suitable medication for any infection. A middle ear sample provides different information from an outer ear discharge sample, because the bacteria may differ. Sampling is planned according to findings; do not try to reach behind the eardrum with cleaning equipment yourself.
Treatment and recovery
Bacterial inflammation may require oral or injected medication. The vet also manages pain and inflammation. Treating ear mites or another underlying factor forms part of care. Medication duration and follow-up depend on disease location, samples and treatment response.
Accumulated middle ear discharge may need removing and the cavity flushing under general anaesthesia. In cats, a partition divides the middle ear cavity, making treatment more complex. An inflammatory polyp needs its own assessment for a procedure. Treating bacteria alone may not remove the tissue change sustaining symptoms.
Surgery may be considered if medication is ineffective, disease recurs or a mass needs removing. Dramatic-looking balance problems alone do not determine the need for surgery. The disease identified and available treatment are what matter.
Safe home care
Do not start old ear drops or vigorous cleaning before receiving advice. Some cleaning products can irritate the middle and inner ear if the eardrum is damaged. Excessive handling can also worsen the problem. Use only products prescribed for this cat and situation.
A cat with balance difficulties needs a safe, confined area without access to stairs from which they could fall. Nausea sometimes requires medication and fluid therapy at the practice. Report an inability to eat or drink. After treatment, balance, hearing changes and eye closure are monitored separately because neurological recovery does not always keep pace with resolution of inflammation.
If hearing loss is permanent
A deaf cat can live safely, but you need to change how you communicate. A spoken call no longer reaches them. A visible hand signal may replace a verbal feeding cue, for example. Approach so your cat can notice you before being touched.
Avoid surprising a sleeping cat by touching them from behind. A gentle movement or vibration through the surface beneath them can signal your presence. Keeping them indoors protects against hazards they can no longer hear, such as approaching traffic. Permanent hearing loss does not mean the ear remains inflamed: pain, discharge or new balance changes are assessed separately rather than attributed simply to deafness.
Prevention
To reduce the risk of middle ear disease, the following are recommended:
- timely treatment of outer ear infections;
- vaccination against respiratory infections, including rhinotracheitis and calicivirus;
- regular ear checks, particularly for at-risk cats;
- avoiding injuries and hypothermia.
Vaccinations protect against particular respiratory diseases, but should not be interpreted as guaranteed protection against middle ear infection or inflammatory polyps. At home, observing the ears' external condition is enough: persistent scratching, discharge and colour changes warrant investigation. Do not insert equipment into the ear canal to search for the cause.
What it means for owners
Middle ear disease in cats is serious and can lead to hearing loss and neurological complications. Remember that a head tilt, purulent discharge or balance problems warrant prompt veterinary care. Early treatment prevents serious consequences.
Early treatment reduces the risk of severe damage, but not every consequence can certainly be prevented or reversed. The prognosis becomes clearer through investigations and treatment response.
Frequently asked questions
Can a middle ear infection occur without discharge?
Yes. Inflammation can remain behind an intact eardrum, so obvious outer ear discharge may be absent. A normal-looking eardrum alone does not rule out disease either. Persistent pain or other compatible findings may require more detailed investigation.
Is an ear polyp cancer?
An inflammatory polyp is a benign inflammatory growth of the lining. It can still cause substantial symptoms and sustain ear disease. Other masses can also occur, so its nature is confirmed through examination and, if needed, a tissue sample.
Will hearing return after treatment?
That depends on the cause of hearing loss and the damage sustained. Some nerve and hearing changes may remain permanent. Keep a deaf cat indoors away from traffic and approach visibly so touch does not startle them.
This article is for general information only and is not a guide to treatment. If you notice the first signs of illness, contact your vet.
Paw4care editorial team
Sources
- Otitis Media and Interna in Animals, Merck Veterinary Manual, accessed 2026-11-02.
- Otitis Media and Interna in Cats (Middle and Inner Ear Infections), Merck Veterinary Manual, accessed 2026-11-02.
- Inflammatory Polyps in Cats, Merck Veterinary Manual, accessed 2026-11-02.
- Vestibular Syndrome, Cornell University College of Veterinary Medicine, accessed 2026-11-02.
- Feline Ear Disorders, Cornell University College of Veterinary Medicine, accessed 2026-11-02.
- Inner Ear Infection (Otitis Interna) in Cats, VCA Animal Hospitals, accessed 2026-11-02.
