What Is an Ear Infection?

Ear infections can occur in the inner, middle, and outer parts of the ear. Outer ear infections are the most common for adults. Middle ear infections (otitis media) occur more often in children, but 20% of adults get them too.

Bacterial, viral, or fungal infections can cause ear infections. Allergies, exposure to cigarette smoke, too much water in the ear for too long, and fluid buildup can also be the culprits. Treatment for an ear infection ranges from self-care to surgery, depending on the underlying cause.

This article reviews types of ear infections, symptoms, causes, diagnosis, prevention, treatment, and outlook.

Types of Ear Infections

Healthcare providers classify ear infections by their location, as follows:

• Middle ear infection (otitis media): The clinical term for middle ear infections is "otitis media" ("bilateral otitis media" when it affects both ears). Otitis media is most common in babies and young children.
• Outer ear infection: Otitis externa is an infection of the outer parts of the ear canal. It is commonly referred to as “swimmer's ear” because it can occur after getting water in the ears from prolonged exposure.

Ear Infection Symptoms

The symptoms of an ear infection vary depending on the location (type). Symptoms can come and go or remain constant. They also range in severity, depending on the level of infection. 

Inner Ear Infection

Inner ear infections can cause the following:

• Balance problems
• Dizziness 
  
• A feeling of fullness in the ear 
  
• Headache
  
• Hearing problems
  
• Nausea, vomiting
• Tinnitus (ringing in the ears)
  
• Vertigo (spinning sensation)
  

Middle Ear Infection

Symptoms of otitis media infections include:

• Congestion, fullness, pressure
• Earache 
• Fever
• Fluid drainage
• Hearing problems
  
• Trouble sleeping

Outer Ear Infection

Outer ear infections may cause:

• Ear pain 
  
• Ear drainage (a yellow or white liquid)
• Hearing problems
• Itching
• Rash or flaking skin 
• Redness
• Swelling

Baby Ear Infection Symptoms

In addition to the symptoms mentioned above, you may also notice the following symptoms in your baby or young child:

• Rubbing or tugging at their ears
• Not responding to sound
• Fever
• Appetite loss
• Balance issues
• Fussiness (excessive crying or irritability)

What Causes Ear Infections?

The most common cause of an ear infection is a pathogen (germs such as bacteria, viruses, or fungi). The common pathogen type is more specific to the infection location, as follows:

• Inner ear infections are typically due to a virus such as influenza or Epstein-Barr. 
• Middle ear infections occur from fluid buildup behind the eardrum, typically due to bacterial or viral respiratory illnesses. This includes colds, respiratory syncytial virus (RSV), influenza, or sinus infections. While allergies are not an infection, they can clog or inflame the eustachian tubes and lead to infection. 
• Outer ear infections: Bacterial infections are the most common cause of outer ear infections, but fungus (like the one that causes athlete's foot) can also cause them.  

The following are general risk factors for ear infections:

• Allergies 
• Exposure to tobacco smoke (including secondhand smoke)
• Acid reflux
• Altitude changes
• High humidity, heat
• Family history
• Recent respiratory illness or ear infection
• Trauma to ear/broken skin (increases risks for an outer ear infection)
• Multiple infections as a child

In addition, the following scenarios put babies and young children at higher risk:

• Low birth weight
• Pacifier use
• Daycare 
• Problems with eustachian tube functioning
• Not being breastfed 
• Taking a bottle or sippy cup while lying on their back 

Why Do Adults Get Ear Infections?

Outer ear infections are the most common type in adults. Adults with eczema, or those who frequently use cotton swabs in their ear canal, are at higher risk. 

While middle ear infections are more common in children, 20% of adults also get them. The underlying cause is inflammation in the nasal cavity and throat due to allergies, a cold, flu, sinus infection, or strep throat.

Why Do Babies Get Ear Infections?

Otitis media is common in infants and young children. They are more prone to middle ear infections because their eustachian tubes are shorter, smaller, and more narrow. This makes it easier for pathogens to get into the middle ear and for the tubes to clog. 

Infants typically get ear infections from a respiratory infection, but they can also get them from:

• Allergies
• Excess saliva and mucus during teething
• Overgrown adenoids (tissue in the back of the throat)
• Exposure to smoke

Can Ear Infections Go Away on Their Own Without Treatment?

Many ear infections go away on their own or with minimal treatment within a few days. 

However, if ear infection symptoms persist longer than a couple of days or worsen, it’s important to see a healthcare provider. Symptoms of ear infections can be a sign of something serious. Some ear infections can lead to long-term complications, including hearing loss, if left untreated. 

If infants under 6 months old have a fever, they should see a healthcare provider as soon as possible. Children over 6 months old should see a healthcare provider if they have a fever over 102 degrees F, have severe ear pain, or appear ill.

How to Diagnose an Ear Infection

Your healthcare provider will use an instrument called an otoscope to examine your ears when diagnosing an ear infection.

Healthcare providers might also use tympanometry to identify reasons for hearing loss. During this test, providers use a device called a tympanometer, which is similar to an otoscope, but it delivers sound waves and creates a vacuum. This helps providers evaluate the eardrum and indirectly measure middle ear pressure.

When they look in your ears with the otoscope, they are checking for:

• Discharge
• Redness
• Bulging eardrum
• Air or fluid behind the eardrum
• A hole in the eardrum

Ear Infection Treatment

Ear infection treatment depends on the underlying cause, severity of symptoms, and length of infection. 

Over-the-Counter Treatments

Some ear infections clear up on their own with rest and a warm compress. Others may require mild over-the-counter (OTC) treatment such as:

• NSAIDS (nonsteroidal anti-inflammatory drugs), such as Advil or Motrin (ibuprofen)
• Decongestants
• Antihistamines (allergy medications)
• Pain relief ear drops
• Swimmer's ear drops 

Antibiotics or Antifungals

Your healthcare provider may prescribe antibiotics for underlying bacterial infections. For infections due to a fungus, they may prescribe antifungals.

Antibiotics do not work for viral infections, so providers won’t prescribe them for every ear infection. This is to help reduce the risk of antibiotic resistance.

Ear Tube Surgery

If you or your child has an infection that doesn’t go away or recurs frequently, your healthcare provider may recommend ear tubes. Ear tube surgery helps drain fluid in the middle ear, resolving the current infection and preventing future ones. This is a quick surgical procedure in which an ear, nose, and throat (ENT) surgeon (otolaryngologist) puts tiny metal or plastic tubes in the ear drums. 

Ear tube surgery is done under general anesthesia, so you or your child is asleep during the procedure. It begins with a myringotomy, a small incision (hole) in the tympanic membrane (eardrum). The ENT will suction the excess fluid before placing the ear tubes in the incision.

How Long Do Ear Infections Last?

Typically, ear infections last from three days up to two weeks. With middle ear infections, the fluid buildup can remain for a few months but doesn’t always continue to cause symptoms.

If an ear infection makes you or your child feel bad or run a fever, staying home from work and school until you feel better is best.  

Are Ear Infections Contagious?

Ear infections themselves are not contagious. However, the infections that cause some can be contagious. They might spread from person to person through contact with respiratory secretions, coughing, or sneezing.

If someone gets an ear infection from blocked eustachian tubes or bacteria already in their body, there is no risk of spreading the infection.

How to Prevent Ear Infections

Prevention of ear infections begins with good handwashing and avoiding others who are sick. These measures help stop the spread of germs that can lead to ear infections.

Other ways to help prevent ear infections include:

• Not smoking cigarettes and avoiding secondhand smoke
• Keeping up with immunizations
• Breastfeeding infants until they are at least 6 months old, if possible
• For bottle-fed babies, holding them at an angle while they are taking a bottle
• Manage allergies

To help prevent swimmer's ear or outer ear infections:

• Avoid using Q-tips (cotton swabs) or other objects to clean your ears: Using Q-tips to clean your ears can cause trauma or cause them to break off in the ear. If you need to clean your outer ear, use a tissue or soft cloth to wipe around the outer area softly. 
• Remove water from your ears: To remove water in your ear, turn your head to the side and try to shake the water out. You can also lie on your side with a towel under your ear and let it drain. 
• Dry out your ears: If you can't get all the water out naturally, try ear drops such as Swim EAR to dry out your ears. A cool hair dryer may also help. 

Outlook 

Most people fully recover from their ear infections without long-term side effects. Sometimes ear infections cause short-term hearing loss that resolves when the fluid clears. If you or your child has persisting symptoms for more than two or three days, seek treatment. Treatment helps reduce the risk of complications such as hearing loss or permanent damage to your inner ears.