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Ear infections: what you need to know

Ear infections are very common, especially in children. Adults can also get ear infections, but in adults, they can occasionally be a sign of something potentially more serious.

Usually, though, an ear infection will clear up on its own without the need for treatment within three days.

On this page, you can find more information about the causes and symptoms of ear infections and when to seek medical advice.

What is an ear infection?

As the name suggests, an ear infection is when a part of the ear becomes infected, normally by bacteria or a virus – causing pain and inflammation.

There are three types of ear infections, each one named according to the part of the ear that’s affected – the inner, outer, and middle ear.

Inner ear infection

Infection of the inner ear is sometimes referred to by its medical name, otitis interna, which literally translates to ‘inflammation of the inner ear’.

It affects the inner part of the ear called the labyrinth or vestibular system, which is involved in hearing and balance. It’s sometimes called labyrinthitis or vestibular neuritis.

An inner ear infection can be caused by a virus or bacteria, but sometimes it’s inflammation rather than infection that causes symptoms. It’s far more common for a virus to cause an inner ear infection than bacteria.

Occurring less commonly than an infection of the middle ear, an inner ear infection typically causes problems with balance – like dizziness and vertigo – as well as with hearing.

Outer ear infection

Outer ear infections, or otitis externa, are usually caused by bacteria in the outer part of the ear.

The outer ear is the part of the ear you can see, called the auricle or pinna – including the ear lobe, the cartilage at the top of the ear, and the bowl of the ear (called the concha) – and the outer part of the ear canal.

closeup of the outer ear of a man

Sometimes resulting from a virus or allergies, outer ear infections are usually caused by bacteria and are a very common source of ear pain.

Fungal ear infections are quite rare – about 1 in 8 outer ear infections are fungal – and they are more common in tropical and subtropical climates.

Quite often it happens as a result of water in the outer ear canal because it hasn’t dripped or drained out properly. For that reason, it’s quite common in people who swim a lot, and is known as ‘swimmer’s ear’.

Middle ear infection

The most common type of ear infection occurs in the middle ear and is also known by its medical name ‘otitis media’.

Because middle ear infections are the most prevalent type, ear infections in general are often referred to as otitis media. But strictly speaking, this term only relates to infection in the middle ear.

The rest of this page will focus on middle ear infections, unless it’s stated otherwise.

What causes ear infections?

With a middle ear infection, a virus or bacteria infects the air-filled space behind the eardrum. Often, it starts with some sort of infection of the upper respiratory tract – like a cold or flu – that spreads to the middle ear.

The middle ear is connected to the upper part of the throat at the back of the nose by a thin channel, called the eustachian tube.

When an infection strikes the nasal passages or the throat, the eustachian tube gets swollen and blocked, allowing mucus to build up in the middle ear, behind the eardrum.

This creates an ideal environment for bacteria to grow, and causes inflammation and other symptoms.

Ear infections are not contagious – you cannot catch them from someone else. However, the common upper respiratory tract infections that often lead to an ear infection are.

Middle ear infections can be categorized according to whether infection is present and active, and therefore, what symptoms you might have.

  • Acute otitis media – this is the most common presentation. Symptoms come on quickly and can affect your hearing and balance, and generally make you feel unwell.
  • Otitis media with effusion – this can happen after an ear infection, when most of the symptoms have subsided but you still have fluid trapped behind the eardrum.
  • Chronic otitis media with effusion – this occurs when the fluid in the middle ear is present for a long time after the initial infection, or keeps coming back even without any sign of infection. This can cause longer-term hearing difficulties.

What are the symptoms of ear infections?

Broadly speaking, ear infection symptoms may be similar whether the infection is in the inner, outer or middle ear.

The main symptoms of ear infection include:

  • Pain inside the ear (earache)
  • Difficulty hearing
  • Feeling dizzy or having problems with balance
  • A sensation of fullness in the ear
  • Ear feeling blocked or clogged
  • Headache, and generally feeling congested
  • Being and feeling sick
  • Fever (a high temperature)
  • Fluid draining from the ear
  • Lethargy and generally feeling unwell

With an outer ear infection, you may experience some of the symptoms listed above – such as a degree of hearing loss, a clogged sensation in your ear, and fluid or pus coming from the ear. But as well as those, you may notice that:

  • Your ear feels itchy, irritated, and sore
  • The outer part of your ear is red and swollen
  • You have quite severe pain, especially when you touch your ear
  • When you move your jaw it feels tender
  • The glands around your throat and ear are swollen
  • The skin in your ear canal and outer ear might be flaky, scaly, and oozing

Ear infection symptoms in children

Children are more likely to get ear infections than adults.

That’s because their eustachian tubes are smaller and narrower than those of adults, and their position is vertically more level. That makes it harder for fluid to drain properly, especially if their eustachian tube is blocked.

And a child’s immune system is still developing and is therefore not as strong as an adult’s, and less able to ward off infections.

Ear infection symptoms in babies and children might include:

  • Rubbing or tugging at the ear
  • Irritability, clinginess, and crying
  • Temperature of 100°F (38°C)
  • Cough, runny nose
  • Trouble sleeping
  • Poor feeding, lack of appetite
  • Appearing clumsy
  • Not responding or reacting to quiet sounds

How is an ear infection treated?

Most ear infections don’t need any treatment other than over-the-counter painkillers to help ease pain and lower your temperature. You could also ask your pharmacist to recommend appropriate ear drops.

You might also get some relief from placing a warm compress or cold flannel on your ear. But you should prevent water or shampoo from going into your ear, and avoid the temptation of putting a Q-tip or cotton bud – or your finger – into your ear canal.

Consider seeing your doctor if your symptoms don’t improve after three or four days, or if they worsen rather than subside. In particular, be on the lookout for:

  • Pain that’s very severe and doesn’t go away after a few days
  • Fever, and a temperature of 102.2°F (39°C) or higher
  • More discharge coming from the ear
  • Swelling around the ear
  • Hearing loss that doesn’t seem to improve
  • Severe sore throat
  • Recurring ear infections

If your child has an ear infection and they don’t show signs of improvement within a couple of days, if they are especially irritable or listless, or if they are younger than six months old, seek medical advice sooner.

child with ear infection has ear inspected

You should also see a doctor if you have a long-term medical condition, like heart, lung or kidney disease, and if you have a weakened immune system.

Your doctor might perform an examination and some tests, including basic hearing tests.

They will also ask you some questions about your symptoms and medical history, and whether or not you’ve had similar problems before.

If they suspect your ear infection is viral, it’s unlikely they will prescribe anything to treat it, other than the over-the-counter remedies suggested above. Antibiotics that are used to treat bacterial infections do not work on viral infections.

If there are signs that your ear infection is caused by bacteria, or if you’ve had an ear infection for more than a week or so, your doctor should prescribe antibiotics. As with any medication, it’s important to complete the full course of treatment as prescribed.

If it’s your child who has an ear infection, your doctor should closely monitor them going forward to make sure recurrent ear infections don’t go unnoticed.

When an ear infection has cleared up, you might still have fluid remaining but it should correct itself within a month or two.

Can an ear infection cause hearing loss?

A degree of hearing loss when you have an ear infection is quite common. It might come and go for a few weeks after the infection has subsided if you have fluid remaining in the ear, because the passage of sound through your auditory system is blocked.

So, if you or your child have an ear infection and notice a hearing impairment, it’s not usually anything to worry about.

But if ear infections that need treatment go untreated, and if you get lots of ear infections, there is a risk of longer-term hearing loss.

That’s often because of complications arising from an ear infection. One example of this is chronic suppurative otitis media, which happens when ear infections persist and the eardrum bursts, or becomes perforated. It can lead to ongoing discharge from the ear and result in hearing loss.

Although these types of complications are rare, they make the case for prompt diagnosis and treatment of an ear infection.

So, while any type of ear infection is typically mild and self-limiting, it’s important that you keep a close watch on how they develop and seek medical advice if you’re concerned.

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Written by:
Allie Anderson is a health writer and editor with many years of experience creating accurate, evidence-based content for consumer and professional audiences. Allie is passionate about making medical information as accessible as possible, empowering people to make informed choices about their health and well-being. Allie holds a first-class honours degree in Linguistics from University College London, a Russell Group institution that’s ranked in the top 10 universities globally. She trained as a journalist with the UK’s NCTJ (National Council for the Training of Journalists) and after working as a news reporter for local newspapers and B2B titles, began writing about health. Published in medical journals, peer-reviewed magazines for healthcare professionals and a broad range of consumer titles, Allie has covered all manner of health and medical topics throughout her career, most recently focusing on hearing health and hearing loss. Allie has conducted in-depth research into the mechanisms underpinning hearing and has developed an understanding of the nuanced impact hearing loss can have on individuals and their loved ones.
Reviewed by:
Audiologist Ana Paula de Lima Rodrigues (Audiology and Speech Therapy BSc) is extremely passionate about providing exceptional care, advice and support for people with hearing loss. Ana trained at the University of Vale do Itajai in Brazil in 2001 and currently works in London where she is registered with The Health and Care Professions Council (HCPC).
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