Middle and Inner Ear Infection in Cats
A cat's ear has three parts: the visible outer canal (external ear), a small bony chamber behind the eardrum (middle ear), and the inner ear, deeply set within the skull, which controls hearing and balance. Middle ear infection is inflammat...
What is it?
A cat's ear has three parts: the visible outer canal (external ear), a small bony chamber behind the eardrum (middle ear), and the inner ear, deeply set within the skull, which controls hearing and balance.
Middle ear infection is inflammation, usually from an infection, of the middle ear. When it spreads to the inner ear, it becomes inner ear infection: the cat loses balance and tilts its head.
In cats, this infection does not typically start in the external ear canal as it does in dogs. It often follows an upper respiratory infection, with the infection spreading up the small channel connecting the back of the throat to the ear, or develops from an inflammatory polyp, a benign growth in the middle ear.
Commonly observed signs
These signs are neither exhaustive nor specific. Only a veterinarian can establish a diagnosis.
Related signs — each one links to its page:
The cat shakes its head, scratches at the ear, or holds one ear down.
Discharge or bad odor from the ear, which may come and go: the ear may look clean from the outside.
Pain when opening the mouth: the cat chews with difficulty, drops food, or refuses hard foods.
On one side of the face, signs of Horner's syndrome related to nerves passing through the middle ear: the eye appears to sink deeper into the socket, the third eyelid, a clear membrane at the inner corner of the eye, becomes visible, the upper eyelid droops, and the pupil is smaller than the other eye's pupil.
Sometimes one side of the face droops: lower lip hangs, ear is less mobile, upper eyelid does not close properly.
When the inner ear is affected: head tilts toward the affected side, unsteady gait, falls, the cat walks in circles always in the same direction; the eyes may make small involuntary back-and-forth movements.
Nausea or vomiting, similar to motion sickness, at the start of balance problems.
Hearing may decrease on the affected side.
When to consult without delay
This list does not replace veterinary advice. It gathers situations that justify a prompt consultation.
Causes and risk factors
Bacterial infection of the middle ear, most often following an upper respiratory infection or infection of the throat and nose.
Inflammatory polyp of the middle ear, a common cause in young cats: it maintains inflammation and infection.
Rarely, extension from an old external ear infection or neglected ear mites.
Foreign body, head trauma, or ear tumor, exceptionally.
Recent or recurrent upper respiratory infection.
Inflammatory polyp, especially in young cats.
Old or poorly treated external ear infection, untreated ear mites.
Life in a multi-cat environment, where respiratory infections spread easily.
Diagnosis and care
Diagnosis is the veterinarian's responsibility, based on clinical examination and laboratory tests. Care is decided case by case.
The veterinarian examines both ears with an otoscope and observes the eardrum; a thorough examination is often performed under anesthesia because the ear is painful.
A neurological examination is performed to determine whether the inner ear and facial nerves are affected, and to verify that no signs suggest brain involvement.
The back of the throat is examined to look for a polyp.
Imaging—radiography or CT scan—allows visualization of whether the middle ear cavity is filled with fluid or tissue.
A sample of middle ear fluid can be analyzed to identify the bacteria and select the appropriate antibiotic.
Treatment
Infectious middle ear infection is treated with antibiotics, often for several weeks, chosen if possible based on fluid analysis.
Cleaning of the ear under anesthesia may be needed to drain the cavity.
If a polyp is the cause, it must be removed, otherwise the ear infection returns; depending on the case, removal is done through the ear or throat, or by surgery that opens the middle ear cavity.
The veterinarian may prescribe treatment for inflammation, pain, or nausea.
During balance disturbances, the cat should be protected from falling: keep the room quiet, no access to high places, food and water bowls and litter box within reach.
Do not introduce any product into the ear without veterinary advice: if the eardrum is perforated, some products may worsen inner ear involvement.
Treatment depends on the cause and the animal's condition: it must be determined by a veterinarian. No self-medication.
Prevention
Have your cat treated for upper respiratory infection until it is completely cleared, and vaccinate your cat against upper respiratory viruses according to your veterinarian's recommendations.
Have external ear infection or ear itching examined promptly, and treat ear mites.
Consult if a young cat breathes noisily through its nose even while awake: a polyp may be the cause.
Possible complications
Head tilt persisting after recovery: many cats adapt well to this and return to a normal life.
Horner's signs or paralysis on one side of the face, which may be permanent.
Deafness on the affected side.
Corneal drying and ulceration when the eyelid no longer closes.
Rarely, spread of infection to the brain, which is a serious emergency.
Recurrence if a polyp or infection was not completely treated.
When to see a veterinarian
Your cat suddenly tilts its head, staggers, or circles.
Head tilt is accompanied by fever, lethargy, seizures, or behavior changes: consult the same day.
On one side, its eyelid droops, its pupil is smaller, or the third eyelid is visible.
One side of its face droops or its eye no longer closes: consult within the day to protect the cornea.
It shakes its head, has pain while eating, or its ear is draining or has a foul odor.
It had an upper respiratory infection recently and shows any of these signs.
Prognosis
When the cause is found and treated long enough, most cats recover from the infection.
Balance disturbances generally improve gradually, but mild head tilt, Horner's signs, or facial paralysis may persist; these rarely interfere with the cat's daily life.
The prognosis is more guarded in cases of brain involvement or tumor.
Frequently asked questions
How to distinguish it from a vestibular syndrome?
Feline vestibular syndrome begins abruptly, without ear discharge or ear pain, and often improves on its own within a few days. In middle and inner ear otitis, there is often a recent upper respiratory infection, a painful or draining ear, difficulty chewing, or Horner's signs on the same side. Only veterinary examination, sometimes supplemented by imaging, can determine the diagnosis.
What is the connection to the polyp?
An inflammatory polyp is a benign growth that develops in the middle ear and may extend toward the ear canal or back of the throat. It is a common cause of otitis media in young cats. It is often associated with noisy nasal breathing. Unless it is removed, the otitis tends to recur.
Will my cat keep its head tilted?
It's possible. Even after the infection heals, a slight head tilt may persist. Most cats compensate very well, move normally, and return to their usual activities.
Is it the same thing as an ear infection caused by ear mites?
No. Ear mite infestation causes external otitis, with dry brown-black cerumen and itching, without balance disorders. If neglected, however, it can progress and affect the middle ear: this is all the more reason to treat it promptly.
References
Content reviewed by the TunisieVet editorial team · Updated 26 October 2026
Comments (0)
No comments yet.
AT A GLANCE
Need a veterinarian?
Find a practitioner near you on TunisieVet, with their specialities, hours and contact details.
Find a veterinarianCategories
Affected species
This information is provided for educational purposes only and is not a substitute for a veterinary consultation. If you have any concerns about your animal's health, consult a veterinarian.
Thinking of welcoming a pet? Dogs and cats are waiting for a family in Tunisia, and adoption is completely free.
Adoption listingsOn the TunisieVet marketplace
Food, hygiene and accessories for cat, sold by verified shops and delivered across Tunisia.
Buying advice, not medical advice: for a diagnosis or treatment, consult your veterinarian.
To discover
Related diseases and linked Animalia content.
Rabies
Viral · Vaccine available
Hip dysplasia
Other
Otitis externa
Environmental
Periodontal disease
Other
