Ear Infection Causes, Symptoms, Risk Factors, Treatment and FAQs

What is ear infection?

An ear infection (sometimes called acute otitis media) is an infection of the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.

An ear infection occurs when a bacterial or viral infection affects the middle ear — the sections of your ear just behind the eardrum.

Ear infections can be painful because of inflammation and fluid buildup in the middle ear. Ear infections can be chronic or acute. Acute ear infections are painful but short in duration.

Chronic ear infections either don’t clear up or recur many times. Chronic ear infections can cause permanent damage to the middle and inner ear.

Because ear infections often clear up on their own, treatment may begin with managing pain and monitoring the problem. Sometimes, antibiotics are used to clear the infection. Some people are prone to having multiple ear infections. This can cause hearing problems and other serious complications.

Symptoms of an Ear Infection

The ear is a complicated part of the body, made up of several different chambers. Ear infections can strike in any one of these chambers and cause various symptoms.

The three main parts of the ear are known as the inner, middle, and outer ear.

Infections are most common in the middle ear and outer ear. Inner ear infections are less frequent and sometimes a sign of another underlying condition.

Symptoms of ear infections in adults vary depending on location and can include:

inflammation and pain
tenderness to the touch
hearing changes
nausea
vomiting
dizziness
fever
headache
swelling of the ear

Discharge coming from the ear is a sign of a more serious issue and should be diagnosed by a doctor immediately.

Middle ear infections

The middle ear is the area directly behind the eardrum. Middle ear infections are typically caused when bacteria or viruses from the mouth, eyes, and nasal passages get trapped behind the eardrum. The result is pain and a feeling of plugged ears.

Some people may have trouble hearing, as an inflamed eardrum is not as sensitive to sound as it needs to be. There is also a buildup of fluid or pus behind the eardrum, which can make hearing more difficult. It may feel as if the affected ear is underwater.

If the eardrum tears or bursts due to the build of pressure from the infection, fluid may drain from the ear.

A fever and general tiredness can also accompany a middle ear infection.

Outer ear infections

The outer ear extends from the ear canal on the outside of the eardrum to the outer opening of the ear itself.

Outer ear infections can start with an itchy rash on the outside of the ear. The warm, dark ear canal is the perfect place for germs to spread to, and an outer ear infection may be the result.

Outer ear infections can also result from irritation or injury to the ear canal from foreign objects, such as cotton swabs or fingernails.

Common symptoms include an ear or ear canal that is painful, swollen, and tender to the touch. The skin may become red and warm until the infection goes away.

Causes of an Ear Infection

An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes.

Role of eustachian tubes

The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:

Regulate air pressure in the middle ear
Refresh air in the ear
Drain normal secretions from the middle ear

Swollen eustachian tubes can become blocked, causing fluids to build up in the middle ear. This fluid can become infected and cause the symptoms of an ear infection.

In children, the eustachian tubes are narrower and more horizontal, which makes them more difficult to drain and more likely to get clogged.

Role of adenoids

Adenoids are two small pads of tissues high in the back of the nose believed to play a role in immune system activity.

Because adenoids are near the opening of the eustachian tubes, swelling of the adenoids may block the tubes. This can lead to a middle ear infection. Swelling and irritation of adenoids is more likely to play a role in ear infections in children because children have relatively larger adenoids compared to adults.

Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include:

Otitis media with effusion, or swelling and fluid buildup (effusion) in the middle ear without bacterial or viral infection. This may occur because the fluid buildup persists after an ear infection has gotten better. It may also occur because of some dysfunction or noninfectious blockage of the eustachian tubes.
Chronic otitis media with effusion occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection. This makes children susceptible to new ear infections and may affect hearing.
Chronic suppurative otitis media, an ear infection that doesn’t go away with the usual treatments. This can lead to a hole in the eardrum.

Risk factors of Ear Infection

Risk factors for ear infections include:

Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of their eustachian tubes and because their immune systems are still developing.
Group childcare. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home. The children in group settings are exposed to more infections, such as the common cold.
Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.
Seasonal factors. Ear infections are most common during the fall and winter. People with seasonal allergies may have a greater risk of ear infections when pollen counts are high.
Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infections.
Alaska Native heritage. Ear infections are more common among Alaska Natives.
Cleft palate. Differences in the bone structure and muscles in children who have cleft palates may make it more difficult for the eustachian tube to drain.

Treatment of Ear Infection

Depending on the cause, some infections will clear up without treatment. Symptoms may be managed during this time, and a doctor might recommend other treatments to speed up the healing process.

Antibiotics and other prescriptions

According to the Centers for Disease Control and Prevention (CDC)Trusted Source, using antibiotics by mouth to treat ear infections may not be recommended in certain cases of middle and outer ear infections.

Treatment depends on the cause and severity of the infection, along with other health problems a person may have. Antibiotics are not effective against ear infections caused by viruses.

Prescription eardrops may be the way a doctor will treat some ear infections. Prescription eardrops can also sometimes be used to treat pain symptoms.

Over-the-counter medications

Drugs, including acetaminophen (Tylenol) and ibuprofen (Advil), help many adults with ear infections treat the pain associated with the accompanying inflammation. Tylenol and Advil are available to purchase online, and other brands are available.

Decongestants or antihistamines, such as pseudoephedrine (Sudafed) or diphenhydramine (Benadryl), may also help relieve some symptoms, especially those caused by excess mucus in the eustachian tubes. Decongestants and antihistamines are also available to purchase online, as well as over-the-counter.

Drugs such as these may help get rid of the pain of the ear infection, but they will not treat the infection itself.

Complications of an Ear Infection

Most ear infections don’t cause long-term complications. Ear infections that happen again and again can lead to serious complications:

Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually gets better after the infection clears. Ear infections that happen again and again, or fluid in the middle ear, may lead to more-significant hearing loss. If there is some permanent damage to the eardrum or other middle ear structures, permanent hearing loss may occur.
Speech or developmental delays. If the hearing is temporarily or permanently impaired in infants and toddlers, they may experience delays in speech, social and developmental skills.
The spread of infection. Untreated infections or infections that don’t respond well to treatment can spread to nearby tissues. The infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).
Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.

Home remedies of Ear Infection

Non-prescription eardrops may be helpful in treating mild cases of swimmer’s ear. Eardrops can be made at home or purchased over the counter.

According to ear specialists, a simple at-home blend can be made by making a mixture of half rubbing alcohol and half white vinegar. Using a few drops into the ears can help dry out the ear canal and support the healing process.

These drops should also not be used in people who have ear tubes (T-tubes), permanent injuries to their eardrum, or certain ear surgeries.

If the infection is not getting better or other symptoms develop, a person should stop using the drops and see their doctor.

Eardrops should not be used in an ear that has any discharge coming from it unless prescribed by a doctor.

Ear discharge, drainage, or blood is a sign of a bigger complication, such as a ruptured eardrum, which needs immediate medical attention.

Compress

A warm compress may help relieve the pressure building up in the ear as well. Using a compress for 20-minute periods while resting can help reduce pain. This can be done along with other pain treatments, including over-the-counter medications.

How can ear infections be prevented?

The following practices may reduce the risk of ear infection:

washing your hands often
avoiding overly crowded areas
forgoing pacifiers with infants and small children
breastfeeding infants
avoiding secondhand smoke
keeping immunizations up-to-date

Frequently Asked Questions About Ear Infection

The ear is home to the three smallest bones in the human body. Which one of these is NOT one of those three bones?

The three smallest bones in the body are located in the ear and are called the malleus, incus, and stapes (commonly called the hammer, anvil, and stirrup because of their shapes). All together they are referred to as the “ossicles,” and they help transmit sound vibrations from the eardrum to the inner ear.

The cochlea is not one of the bones of the inner ear, but rather a portion of the inner ear that converts sounds into nerve impulses that are sent to the brain.

An otologist is a doctor who specializes in medicine related to the ear. An otologist is a specialized type of otolaryngologist, which is a specialist in disorders of the ear, nose, and throat (also called an ENT).

What is the purpose of earwax?

Earwax, also called cerumen, helps keep the ears healthy by lubricating the ear canals, cleaning out the ears, and trapping dirt and germs.

Doctors encourage “candling” as a way to remove excess earwax. True or False?

Doctors do not recommend ear “candling,” which involves lighting a long, hollow candle (typically made from cloth soaked in beeswax) on one end and placing the other end in the ear canal.

Not only is there no scientific evidence this helps any condition, it is dangerous and can lead to burns, blockages in the ear canal, or perforation of the tympanic membrane in the ear.

Ears are actually self-cleaning and doctors do not advise sticking anything inside the ear, including a cotton swab, because it could push wax further into the ear canal, or even rupture the eardrum. Keep ears clean by wiping the exterior with a soft cloth. If you experience problems with earwax buildup that affect your hearing, consult your doctor.

Balance disorders that cause you to feel unstable or dizzy including Meniere’s disease, vertigo, and labyrinthitis actually originate from the inner ear where the body’s vestibular system is located.

This system has fluid-filled canals that sense movement. Balance disorders are often a result of vestibular system malfunctions.

How can you treat tinnitus?

Tinnitus, or ringing in the ears, can often be treated. If the tinnitus is due to earwax buildup, getting the ears cleaned by your doctor may relieve symptoms. Sound generators such as white noise machines can help mask the ringing noises caused by tinnitus. In more serious cases of tinnitus, cochlear implants may be used to help reduce or mask tinnitus.

How many kinds of ear infections are there?

There are three different types of ear infections:

Otitis media with effusion (OME), or “middle ear infection,” is a buildup of fluid in the middle ear which may occur as a result of a cold or upper respiratory infection
Acute otitis media (AOM) occurs when otitis media fluid becomes infected
Otitis externa also called “swimmer’s ear” is inflammation of the ear canal

Swimmer’s ear is highly contagious from person to person. True or False?

False. Swimmer’s ear (otitis externa) is not highly contagious. When water gets into the ear canal, usually it easily drains out. Sometimes it can remain in the ear canal, giving bacteria a chance to grow and cause an infection. The infection is common in swimmers, but otitis externa can occur in people who have not been swimming.

Most ear infections occur in children younger than six years old. True or False?

True. While anyone can get an ear infection, five out of six children will have at least one ear infection by their third birthday. In fact, ear infections are the most common reason parents bring their child to the doctor.
If a child isn’t old enough to tell you that they are hurting, here are some common signs and symptoms to look for:

Tugging and pulling at the ears
Fussiness and crying
Trouble sleeping
Fever
Fluid draining from the ear
Clumsiness or problems with balance
Trouble hearing or responding to quiet sounds

At what decibel level of sound does one begin to experience hearing loss?

Hearing loss may occur when a person is exposed to sounds at or above 85 decibels for long or repeated periods of time. Sounds of 75 decibels or less do not usually cause hearing loss. The louder the sound, the shorter the time it would take for it to cause problems with hearing. Here is a comparison of the decibel levels of certain common sounds:

45 decibels – the humming of a refrigerator
60 decibels – normal conversation
85 decibels – noise from heavy city traffic (*repeated or prolonged exposure to this decibel level or higher can cause hearing loss)
95 decibels – motorcycles
105 decibels – mp3 player at maximum volume
120 decibels – sirens
150 decibels – firecrackers and firearms

Hearing loss is one of the most common conditions affecting older and elderly adults. True or False?

True. Hearing loss is extremely common in older adults. About one-third of adults between the ages of 65 and 74 in the U.S. has some hearing loss, and about half of those older than 75 have some difficulty hearing. Changes in the ear or along the nerve pathways from the ear to the brain as we age are the most common cause of hearing decline in older adults. Some medical conditions or medications can also affect hearing.