If your cat keeps scratching at their ears, shaking their head, or you notice dark debris or a smell from the ear, something is bothering them. Ear mites are a well-known cause in cats, but they are not the only one, and some ear problems in cats are more serious than they first look.
This guide covers the common causes, what your vet will check, and the signs that need prompt attention.
Signs of an ear problem in cats
Inflammation of the outer ear canal is called otitis externa. Typical signs are head shaking, rubbing or scratching at the ear, redness, swelling, discharge and discomfort when the ear is touched. [1] How it looks depends on the cause: mite infestations tend to be very itchy, and the colour and texture of the discharge can hint at which germs are involved, although only a test under the microscope tells for sure. [1] One or both ears can be affected. [1]
Ear mites
Ear mites (Otodectes cynotis) live on the skin lining the ear canal and feed on debris and ear secretions. [3] They are the leading single cause of outer ear inflammation in cats, behind roughly half of all cases, and they also infect dogs. [1] Kittens, young cats and stray cats are affected more often than older pet cats. [3]
Signs include: [1][3]
- Strong itching, head shaking and scratching at the ears
- Dry, dark brown to black debris in the ears that looks like coffee grounds
- Scratch wounds or sores on the neck and behind the ears
Treatment. Your vet will choose a treatment and may clean out the debris first. [1] The mites can also live on the skin outside the ears, so a plan that only treats the ear canal can let them move back in. [1][3] Some cats and dogs carry mites without showing signs, so all dogs and cats that have contact with an infested cat need treatment too. [1] Tell your vet about every pet in the household.
Infections can cause the same signs as mites, so let your vet confirm the cause by looking at an ear sample under the microscope. [1]
Outer ear infections (otitis externa)
Outer ear inflammation is less common in cats than in dogs. In cats it is most often caused by ear mites or by inflammatory polyps. [1] Vets think about the causes in layers: [1]
- Primary causes that start the problem on their own: mites, foreign material, allergies, polyps and tumors
- Secondary causes that make an already sore ear worse: bacteria and yeast, and irritation from some ear products or from cotton buds
- Predisposing factors such as a canal that stays damp
- Perpetuating factors that keep it going, such as long-term thickening of the canal and middle ear disease
To get an ear infection under control, your vet needs to find and deal with each of these layers, not only the germs. [1] If your cat is itchy elsewhere too, allergies may be part of the picture. See why is my cat itchy or overgrooming? For dogs, see ear infections in dogs.
Ear polyps
Inflammatory polyps are benign growths that start in the lining of the middle ear, the back of the nose and throat, or the ear canal. They are one of the most common causes of middle ear disease in cats. [4] They have long been called a problem of young cats, but they are found at all ages; in one large study most affected cats were adults between 2 and 7 years old, and about half had polyps in both ears. [4] Long-term inflammation of the upper airways is thought to play a part. [4]
Polyps in the ear can cause ear infections, a head tilt, unsteadiness or changes on one side of the face. Polyps that reach the throat can cause nasal discharge, noisy breathing or trouble swallowing. [4] Polyps deep in the middle ear may cause no signs for a long time. [4] Treatment is surgical, and your vet may use a CT or MRI scan to plan it. [4]
Middle and inner ear infections
Inflammation of the middle ear is called otitis media. In cats it most often comes from respiratory germs travelling up the tube that links the throat to the middle ear, and polyps are another cause. [2] In cats it can also go unnoticed, with no clear signs. [2]
Signs to watch for: [2]
- Head shaking, rubbing at the ear, or pain when opening the mouth or chewing
- Holding the head to one side
- Changes on one side of the face, such as a drooping upper eyelid, a smaller pupil, a sunken-looking eye or the third eyelid showing (more common in cats than dogs)
- If the inner ear is involved: a head tilt, loss of balance and flicking eye movements
A head tilt or balance problem is a reason to see your vet promptly.
Swollen ear flap (ear hematoma)
If the ear flap suddenly swells and feels soft and full of fluid, it may be an ear hematoma. Most research on it has been done in dogs. There, a small blood vessel in the ear flap breaks and blood collects between the skin and the cartilage, and head shaking from an ear infection is thought to be a common trigger. [6] Without treatment the swelling can scar and shrink into a thickened, crinkled “cauliflower ear”. [6] Your vet will advise on draining or surgery and will also treat the itch or infection behind the head shaking.
Other ear problems in cats
- Sun damage on white ears. Long-term sun exposure can lead to a skin cancer called squamous cell carcinoma in cats. Pale or white skin is most at risk, and the ears, eyelids and nose are common sites. It often starts as scabs that do not heal and later turn into open sores. [7] Any crust or sore on a white cat’s ear tip that does not heal is worth a vet check.
- Tumors. Tumors of the ear canal are uncommon in cats, but when they do occur, more than 80% are malignant. [5] A problem in one ear that does not respond to treatment, or a lump in the canal, needs a proper look. [1][5]
What your vet will check
Your vet will ask about the history and examine your cat, including the face, the mouth and the ear flaps. [1] They will look into the ear canal with an otoscope for debris, foreign material, mites, growths and damage to the eardrum; mites can sometimes be seen moving. Some cats need sedation for this if the ear is painful. [1] Ear samples are checked under the microscope, one for mites and one for bacteria and yeast. Vets consider this test essential, not optional. [1] If the middle ear may be involved, a CT or MRI scan can help. [1][2]
Treatment, and what not to do at home
Your vet will treat the underlying cause and any infection. Cleaning and drying the ear canal, plus medicine applied in the ear, are usually part of the plan, tailored to your cat. [1] The first cleaning is best done at the clinic, where the eardrum can be checked first. [1] Rechecks with a new ear sample show whether the treatment is working, and treatment continues until the infection is gone. [1] If your cat’s ears get redder or more sore after starting a new ear product, stop and call your vet, because some cats react to ear medicines or cleaners. [1]
Avoid home remedies. Several ingredients used in ear products, including vinegar (acetic acid) and peroxide-based wax softeners, can harm the middle ear if the eardrum is torn, and only your vet can see whether it is intact. [1] Do not push cotton buds into the ear canal either, as they can injure it. [1] Use only the ear products and cleaning method your vet shows you.
More cleaning is not better. Frequent cleaning can leave the ear canal damp, which makes problems more likely. [1] Instead, look at your cat’s ears regularly and book an exam if you notice discharge, redness, swelling, a smell, scabs or hair loss.
When to see your vet
Book a visit if your cat:
- Scratches their ears or shakes their head often
- Has discharge, a smell, redness or swelling in the ear
- Has a swollen ear flap
See your vet promptly if your cat:
- Tilts their head, loses balance, walks unsteadily or has trouble jumping [2]
- Has changes on one side of the face, such as a drooping eyelid
- Has a problem in one ear that does not clear up with treatment
- Has a sore or crust on the ear tip that does not heal
FAQ
How do I know if my cat has ear mites?
Strong itching, head shaking and dark, coffee-ground-like debris are typical, but infections can look similar. [1][3] Your vet can confirm mites by looking at an ear sample under the microscope. [1]
Can I treat my cat’s ear mites at home?
Ear mites need a treatment plan from your vet, because mites can also live on the body and other pets can carry them without signs. [1] Do not put home remedies such as vinegar or peroxide in the ears. [1]
Should I clean my cat’s ears?
Only if your vet advises it and shows you how. Frequent cleaning can leave the canal damp and make problems more likely. [1]
Why is my cat tilting their head?
A head tilt can be a sign of a middle or inner ear problem, including polyps. [2][4] See your vet promptly.
Can ear mites spread to my dog?
Yes. Ear mites also infect dogs, and all dogs and cats in contact with an infested cat should be treated. [1]
The bottom line
Ear scratching and head shaking in cats are often caused by ear mites or an outer ear infection, but polyps, middle ear disease and tumors can cause similar signs. Your vet can look inside the ear, find the cause and give a treatment that clears it fully. Skip home remedies, and see your vet promptly if your cat tilts their head or loses balance.
This article is for general information and is not a substitute for veterinary advice. If your cat has an ear problem, please see your veterinarian.
Sources
- Torres SMF. 2.10 Otitis Externa: Dogs and Cats. Small and Large Animal Dermatology Handbook, Vol. 1. University of Minnesota, 2025. CC BY 4.0. https://open.lib.umn.edu/animaldermatology/chapter/otitis-externa-dogs-and-cats/
- Torres SMF. 2.11 Otitis Media: Dogs and Cats. Small and Large Animal Dermatology Handbook, Vol. 1. University of Minnesota, 2025. CC BY 4.0. https://open.lib.umn.edu/animaldermatology/chapter/otitis-media-dogs-and-cats/
- Ribeiro Campos D, et al. Efficacy of Oral Sarolaner for the Treatment of Feline Otodectic Mange. Pathogens. 2021. CC BY 4.0. https://pmc.ncbi.nlm.nih.gov/articles/PMC8001191/
- Demirutku A, et al. Feline inflammatory aural polyps: a retrospective imaging-based evaluation. Front Vet Sci. 2026. CC BY 4.0. https://pmc.ncbi.nlm.nih.gov/articles/PMC12975470/
- Wisnoski M, et al. Computed tomographic findings in 25 cats with ear canal neoplasia. Vet Radiol Ultrasound. 2025. CC BY 4.0. https://pmc.ncbi.nlm.nih.gov/articles/PMC11649876/
- O’Neill DG, et al. Reporting the epidemiology of aural haematoma in dogs and proposing a novel aetiopathogenetic pathway. Sci Rep. 2021. CC BY 4.0. https://pmc.ncbi.nlm.nih.gov/articles/PMC8578590/
- Dos Anjos DS, et al. Comparison of two different doses of bleomycin in electrochemotherapy protocols for feline cutaneous squamous cell carcinoma nonsegregated from ultraviolet light exposure. Sci Rep. 2020. CC BY 4.0. https://pmc.ncbi.nlm.nih.gov/articles/PMC7591921/