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What Causes infections



Prof Guri Sandhu

Posted in

The ‘germs’ that cause Ear, Nose and Throat infections can be viruses, bacteria and fungi.

Viral Infections

Viral infections are common and are usually associated with ‘cold’ and ‘flu’ like illnesses.
Nasal congestion, runny nose, loss of smell and sneezing are common. They can also cause middle ear infections leading to blocked ears and sometimes temporary hearing loss. Other symptoms are sore throat and voice changes. General malaise, pyrexia and cough are often present. These symptoms are self-limiting in the majority of cases. The advice is to rest, keep well hydrated and maintain healthy nutrition. Paracetamol and ibuprofen will help with the temperature and pain. A nasal decongestant will help with the blocked nose and sinus pressure, but is only recommended for short periods. Anti-viral drugs are not prescribed for these types of illnesses. Complications related to these viruses are usually due to secondary bacterial infections. In cases of prolonged illness, and following examination by a doctor, antibiotics may be given.

‘Glandular fever’ is a contagious infection due to the Epstein-Barr virus (EBV). It is also called infectious mononucleosis and has is referred to as ‘Mono’ in the USA. It results in a fever, sore throat, swollen glands in the neck and sometimes a rash. The tonsils will often be enlarged, inflamed and covered with discoloured exudate. Diagnosis is made on the clinical picture, helped by an appropriate blood test. Symptoms of fatigue and sore muscles can persist for many weeks. Management is conservative, as described above. Bacterial complications may require antibiotics.

The highly contagious disease, caused by the COVID-19 virus, resulted in a World-wide pandemic and millions of deaths. It is a mild illness in most patients, common ENT symptoms are a sore throat, cough, temperature and loss of smell and taste. The Omnicron variant is linked with a runny nose and congestion. Some patients required hospitalisation, and in extreme cases, death occurs due to sepsis, lung damage or organ failure. Social distancing, mask wearing, screening and vaccinations have helped to limit spread.

Bacterial Infections

The most common bacterial ear, nose or throat infection involves the throat and can lead to soreness, sometime with voice (laryngitis) or swallowing (dysphagia) problems. The organism is usually a streptococcus but other bacteria may be involved. Infection of the tonsils (tonsillitis) can produce more severe throat pain, temperature and swallowing problems. Treatment is antibiotics if the infection persists beyond a few days.
Rare complications of an untreated bacterial throat infections include a Quinsy (peritonsillar abscess), where pus forms between the tonsil and the wall of your throat. This may require antibiotics and drainage by an ENT specialist. Infections can also spread to other tissue spaces in the neck, often requiring medical treatment and surgical drainage.

Bacteria can also infect the nose and sinuses (sinusitis) producing nasal blockage, facial pain, headaches, discoloured discharge and pyrexia. If conservative measures fail then antibiotics and nasal decongestants may be prescribed. Patients with recurrent sinusitis or persistent sinusitis may be recommended sinus surgery by an ENT specialist.

Sometimes bacteria from the nose or throat can travel up the Eustachian tube (connecting the back of the nose to the middle ear) and produce a middle ear infection (acute otitis media) causing severe pain, hearing loss and even dizziness. Very rare complications are a more severe middle ear infection (mastoiditis) or meningitis. Treatment is with antibiotics and nasal decongestants.

Ear Canal infections (otitis externa) frequently result from swimming in contaminated water or trauma to the ear canal from cotton buds, hair pins or other implements to remove wax. Pain can be severe, there may be a discharge, and if the ear canal swells it can become blocked, and hearing loss may occur. Usually a culture swab will be taken from the ear and topical antibiotic drops prescribed. If more severe, suction cleaning of the ear canal and the insertion of a ‘wick’ may be necessary by an ENT specialist. The wick allows the ear drops to treat the entire ear canal, even if narrowed. In these circumstances antibiotics may also be given by mouth.

Fungal infections

Oropharyngeal candidiasis (also known as oral thrush) is linked to the overgrowth of a fungus such as candida albicans. This can be seen in patients who use steroid inhalers for chest problems but also in individuals who are immune suppressed or immune compromised, or following radiotherapy. Treatment is usually with topical antifungal medications but in extreme cases systemic antifungals may be necessary.

Fungal ear infections usually involve the ear canal (fungal otitis externa) and can follow an over-treated bacterial ear infection. The fungus involved is usually an aspergillus, but sometimes candida species may be involved.
A swab should be taken for micro-organism culture studies. Treatment is though microscopic suction clearance of the debris in the ear canal by an ENT specialist, and topical antifungal drops for up to 3 weeks.

Fungi can affect the nose and sinuses in different ways. Allergic fungal sinusitis is an allergic reaction, in individuals with a healthy immune system, to the presence specific fungi or their spores, that have been filtered by the nose. Symptoms are commonly those of nasal allergy such as nasal congestion, sneezing and runny nose. Treatment is avoidance and topical nasal sprays. In severe cases the sinuses may become blocked with thick mucus and sinus surgery may be necessary.
In rare cases, in patients with a poorly functioning immune system, it is possible to develop an invasive fungal sinus infection that destroys tissue and bone and can lead to death if not treated with emergency surgery and aggressive systemic antifungals.


The symptoms of ear, nose and throat infections are usually mild and they should start to improve after a few days. The advice is for rest, hydration and keeping warm. Paracetamol and ibuprofen can be taken to control the pain and any temperature. Nasal decongestants, used for short periods, may help with a blocked nose or sinus pressure symptoms.

If the symptoms persist you should consult your family doctor in the first instance. See an ENT specialist if the symptoms are particularly severe, last longer than expected, or keep recurring.