Ear Infection

What is an ear infection?

The ear is made up of three different parts. All of them can become infected by bacteria, viruses or less commonly fungi. Ear infections most commonly affect children but adults get them, too.

The ear goes from the outside opening into a canal that leads to the eardrum. The parts are called the outer ear, the middle ear, and the inner ear. They all work together to help you hear sound. The inner ear also helps maintain a sense of balance.

Any of these parts of the ear can become infected. The two most common ear infections are in the outer ear (otitis externa) and middle ear (otitis media). They can be very painful. This pain is caused by inflammation in a very small space with a high number of nerves.

Symptoms may vary depending on where the infection is located. Luckily, once an ear infection is diagnosed there are effective treatments, and in some cases, the infection goes away on its own.

Most common symptoms

Symptoms of an ear infection depend on which part of the ear is infected. In general, they can be painful, but the level of pain varies. There may also be itching, redness, ringing in the ears, hearing loss, or fever.

Ear infections may happen at the same time as the common cold or flu. So you may have cold symptoms such as a sore throat, cough, sneezing, fever, and a stuffed-up nose.

Symptoms of infection in the outer ear (also called the ear canal):

• Pain when you touch the outside of your ear or pull down on your earlobe
• Itchiness in the ear canal
• Visible redness
• Drainage from the ear canal that can vary from whitish to yellow-green, and can be thick or thin and watery
• Scaly skin around the ear canal

Symptoms of infection in the middle ear:

• Sounds are muffled or seem far away
• Feeling of fullness in the ear
• Pain
• Drainage
• Fever

Symptoms of infection in the inner ear:

• Hearing loss
• Pain
• Nausea with or without vomiting
• Dizziness
• Trouble keeping your balance
• Ringing in the ears

What causes an ear infection?

Ear infections can be caused by bacteria, fungi, or viruses. Middle ear infections can also be caused by fluid in the middle ear that does not drain. Over weeks to months, the fluid buildup may become infected, which leads to a middle ear infection. This happens more often to children and infants because the space in their middle ear is so small.

Outer ear infections are more common in people who spend a lot of time in water—like frequent swimmers. Some people have a more narrow ear canal, which can also increase the chances of an infection.

In some cases, enlarged adenoids in the back of the throat can contribute to ear infections by blocking the eustachian tubes and preventing proper drainage of mucus and air.

People with weaker immune systems are more likely to get ear infections. So anyone taking chemotherapy or other medications such as steroids should be on high alert. People with diabetes are also more likely to get ear infections and have a higher risk of complications.

Next steps

Most ear infections are mild and don’t require a trip to the ER. If you think you or your child has one, see your doctor as soon as possible.

Certain symptoms can be a sign of a severe infection and require medical evaluation as soon as possible. Watch out for a very high fever (104° F or higher), a severe stiff neck, swelling behind the ear, weakness of the same side of the face as the affected ear, and severe or continuous vomiting. If you have any of these symptoms, you may need to be evaluated either in the emergency room or an urgent care.

In addition, if you are immunocompromised (taking chemotherapy or prolonged steroids) or have untreated diabetes, you should seek medical attention from your doctor with any concern for an ear infection. Patients with these problems are at a higher risk for much more aggressive and complicated ear infections.

How do you clear up an ear infection?

For ear infections caused by bacteria, doctors may prescribe oral antibiotics or ear drops.

If your doctor suspects that the infection is not bacterial, the treatment may be different. Ear infections caused by viruses do not respond to antibiotics. Like most viral infections, treatment focuses on hydration and medication to lessen pain and reduce fever. Ear infections caused by fungi may be treated by your doctor with antifungal medication by mouth or in ear drops.

• Ear drops: If the infection is caused by bacteria or fungi, your doctor may prescribe ear drops with antibacterial or antifungal ingredients. Use exactly as prescribed. Do not stop taking drops early if symptoms get better.
• Suction: If you’ve been prescribed drops, in the clinic, your doctor may use a small suction device and an otoscope to drain water and clear away any debris. If your ear canal is blocked or swollen, your doctor may also insert a small piece of cotton or gauze to encourage drainage. These procedures allow medicated drops to reach all affected parts of the ear.
• Oral antibiotics: A mild ear infection typically won’t require oral antibiotics, but a severe one might. In most cases of outer ear infection and some middle ear infections, antibiotic ear drops are more effective than oral antibiotics. Antibiotic drops can be much stronger and avoid most potential complications of oral antibiotics.
• Pain medication: To relieve outer ear pain, your doctor may suggest over-the-counter non-steroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (Advil or Motrin).

Will an ear infection go away on its own?

Sometimes, yes. But many cases will need some type of treatment.

Most ear infections go away in anywhere from 2 to 14 days. If you are prescribed antibiotics but still have a fever or other symptoms after 3 days, call the doctor. You might need an alternate treatment. Finish all prescribed medications exactly as directed, even if you start to feel better.

How do you know if your child has an ear infection?

Children are more prone to middle ear infections because of the shorter length of little tubes (called eustachian tubes). These drain the middle ear of fluid and connect the middle ear to the back of the throat. When the middle ear can’t completely drain through these small tubes, infections more easily develop.

Symptoms of ear infection in babies and young children include fever, crying, fussiness, trouble eating and sleeping, and pulling or tugging on the affected ear. Ibuprofen (Advil) can help with fever. But never give a child aspirin. It could cause life-threatening illnesses.

Prevention

Middle and inner ear infections are hard to avoid. To prevent outer ear infections, try to keep ears dry after swimming. Gently tip your head from side to side to encourage water to drain. Carefully pat around the outer ear canal with a dry towel.

Never insert cotton swabs or anything else into the ear canal because you can push earwax further back into the ear. It can lead to blockage and boost the risk of infection.