Ear infections can be painful, so it’s important to act fast. Learn about ear infection symptoms, ear infection types, and what to do if you think you have one.

By Nancy Rones
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When talk turns to ear infections, a crying toddler or infant might come to mind. While these painful bugs do strike little ones in bigger numbers, adults can also suffer from the symptoms of ear infections, so if you feel you have one, don't ignore it. Depending on individual factors such as the severity or progression of a person’s symptoms, earlier diagnosis and treatment can limit possible complications or the need for additional medical or even surgical treatment, says Gavin Setzen, MD, a board-certified otolaryngologist and president of Albany ENT and Allergy Services, PC in Albany, New York. Ear infections can arise in the inner, middle, or outer ear and are driven by either a bacterial or viral infection (as a quick reminder, antibiotics can’t fight viruses). Some ear infections may be acute, meaning they come on quickly for a short stint; others can be a chronic nag, lingering for a long time or constantly recurring. Here’s the lowdown on the three types of ear infections.

Inner Ear Infection

The organs linked to hearing and balance reside in the inner ear. When an infection inflames either the inner ear or the nerves that send signals between the inner ear and the brain, the messages to the brain get scrambled and you experience uncomfortable symptoms, according to the Vestibular Disorders Association (VeDA). Fortunately, inner ear infections aren’t super common—but when they do happen, adults are usually the victims.

Symptoms

An inner ear infection can swell the vestibular nerve that’s linked to balance (an issue called vestibular neuritis), or cause inflammation in both the vestibular nerve and the cochlear nerve (that sends sound signals to the brain); this latter problem, referred to as labyrinthitis, can throw off hearing as well as balance.

Patients with inner ear infections often wind up in the emergency room, since symptoms can be bad and not what people would associate with an ear infection, says Dr. Setzen.

Symptoms of inner ear infection:

  • Dizziness/vertigo that often becomes severe and then gradually improves
  • Possible hearing loss
  • Nausea
  • Vomiting
  • Possible ringing in the ears

Causes:

An inner ear infection is usually caused by a virus. You could have a viral infection that affects the whole body, such as mono, or one that’s limited to the inner ear. According to VeDA, not all of the viruses linked to inner ear infections have been pinpointed, but some that have been identified include:

  • Herpes viruses (such as the one that cause shingles)
  • Influenza
  • Measles
  • Hepatitis
  • Epstein-Barr

The passing of an inner ear infection and disappearance of symptoms can feel like reason to celebrate, but you should know that the virus remains dormant in the body and can unpredictably flare up again.  

Treatments:

Treatments: You’ll likely need to be seen by an otolaryngologist, or Ear, Nose, Throat (ENT) doctor who specializes in the inner ear for a full exam to confirm you have an inner ear infection, rather than an issue such as migraine or a tumor involving the hearing or balancing structures, says Dr. Setzen.

Typically with an inner ear infection, you treat the symptoms and let the virus run its course. Medication to suppress the dizziness and nausea may be prescribed; sometimes IV fluids are given when there’s vomiting. Depending on the situation, an oral steroid or anti-viral drug may also be given.

Middle Ear Infection

The middle ear is the space behind the eardrum that houses the ear’s tiny vibrating bones. Middle ear infections (called “otitis media” by medical pros) is the type of ear infection that drives so many children to pediatricians. While less common in adults, certain people are at increased risk, including those who smoke (or live with smokers), suffer from environmental allergies, or have a viral or bacterial upper respiratory infection.

Symptoms of middle ear infection in adults:

  • Ear pain (from the pressure of fluid on the eardrum)
  • Liquid draining from the ear
  • Trouble hearing in the affected ear
  • Fullness or pressure in the ear
  • Slight dizziness
  • Possible fever

Causes:

Allergies or an upper respiratory infection, such as a cold or the flu, often lies at the root of a middle ear infection. When you’re sick and congested, your eustachian tubes—the long, skinny tube between the middle ear and back of your throat that drain secretions from the middle ear—can become swollen or clogged; as a result, mucous gets trapped in the middle ear, creating a perfect moist environment for germs to multiply and cause ear infection symptoms. It makes sense that more people are diagnosed with middle ear infections in the winter, during cold and flu season (yet another reason to get your flu shot).

Another set-up for infection is exposure to first-hand or secondhand smoke, which can irritate and ultimately obstruct the eustachian tubes.

Treatments:

It’s best to see a healthcare provider if you have symptoms of an ear infection that are accompanied by a fever over 102 degrees, notice fluid leaking from your ear (a sign that your eardrum might have ruptured), or if your symptoms worsen or persist after two to three days, says Jaclyn Chasse, a naturopathic doctor in New Hampshire and immediate past president of the American Association of Naturopathic Physicians.

Unless a bacterial infection is obvious, your medical provider may want to hold off on dispensing antibiotics to see if your immune system fights off the infection (antibiotics won’t help if the infection is caused by a virus, and Dr. Setzen says the vast majority of upper respiratory tract infections are viral). Middle ear infection treatment includes over-the-counter pain relievers such as ibuprofen or acetaminophen, as well as decongestants and plenty of fluids; antihistamines, saline nasal irrigations, and intranasal steroids may be recommended to allergy sufferers.

If you’ve seen your primary care physician and the initial treatment isn’t improving symptoms or fluid isn’t clearing or keeps recurring, you should request a referral to an ENT for further evaluation and testing. The ENT has special tools to clean out the ear canal and to get a good look at what’s going on. “When fluid isn’t clearing in adults, it raises concerns about the possibility of another underlying cause, such as a nasal polyp or tumor, which you don’t want to miss,” says Dr. Setzen. “A chronic ear infection can lead to ear drum perforation and in infrequent cases, lead to as serious a complication as meningitis.”

Outer Ear Infection

An outer ear infection is actually an ear canal skin infection, or in medical terms, otitis externa; it’s more widely known as “swimmer’s ear”. The ear drum, middle ear, or inner ear aren’t usually involved. While avid swimmers are most prone to this type of painful infection, you don’t have to be a pool lifeguard or train as hard as Olympian Katie Ledecky to succumb to swimmer’s ear. Signs of swimmer’s ear often strike within a few days of swimming. Partaking in other outdoor activities, besides swimming, can sometimes also increase your chance for swimmer’s ear, and patients with mold allergies can be more vulnerable to the symptoms of an outer ear infection, especially in the spring and fall, says Dr. Setzen.

Symptoms:

  • Muffled hearing
  • Pain when you tug or push on the ear
  • Itchiness inside the ear
  • Redness and swelling of the ear
  • Drainage from ear

Causes:

The most common scenario with swimmer’s ear: Contaminated water from pools, lakes, or other bodies of water hang out in the ear canal for prolonged periods of time, which sets the stage for an infection to flourish.

Using cotton swabs can cause abrasions on the skin of the ear canals that allow foreign bodies to gain entry; these “bad guys” could be organisms from water or even sand and dirt, which can cause infection in the moist environment.

The majority of outer ear infections are bacterial, but they can be associated with fungal infections, especially in people with mold allergies or hypersensitivities. These fungal infections can be itchy, and scratching the skin of the ear canals, similar to cotton swabs, can cause abrasions that allow germs inside.

Treatment:

Oftentimes, all that’s needed for outer ear infection treatment are prescription antibiotic drops or antibiotic-corticosteroid combination drops.

First though, an ENT needs to clear the debris from the ear canal to both correctly diagnose swimmer’s ear and to ensure that the antibiotic ear drops are able to get into the ear canal and be effective, says Dr. Setzen, who adds that sometimes the ear canals are swollen shut.

To prevent swimmer’s ear, the CDC recommends wearing a bathing cap or ear plugs in the water, towel-drying your ears after swimming or even showering, and aiming a hair dryer on a low setting toward ear canals to get rid of wetness.

Are Ear Infections Contagious?

While the bacterial or viral infection that causes an ear infection can be passed between people, ear infections themselves aren’t contagious.

Home Remedies for Ear Infections

In many cases, the recommendation these days is to ‘wait and watch’ before giving antibiotics, since a large percentage of ear infections will resolve on their own within a few days, says Dr. Chasse. This waiting period is the ideal time to use natural home remedies for ear infections, since they can ease discomfort and improve immune function to resolve the infection sooner. Before trying any natural treatment, always consult with a doctor (ideally one who is knowledgeable about supplements) to ensure the treatment is right for you and that your ear pain doesn’t warrant additional or alternative treatment.

A few of Dr. Chasse’s favorite ear infection home remedies:

  • Soothing warm compresses. You can place a washcloth soaked in hot water over a sore ear, or heat half an unpeeled onion in a conventional or microwave oven and hold it about a half-inch to one inch away from your ear (it’ll be too hot to place on your ear). “It sounds silly, but onions contain antimicrobial compounds that become airborne when heated and can work topically on the outer ear,” says Dr. Chasse.
  • Garlic oil. Steep chopped fresh garlic in warm olive oil on the stovetop and simmer for 5 to 15 minutes. With a medicine dropper, put two to three drops into the affected ear every 2 hours. “Garlic is another fantastic antimicrobial substance.” To boost the benefit of this garlic oil, add dried mullein (available in health food stores) to the oil while it’s simmering; the herb mullein has pain relieving and anti-inflammatory properties.
  • Elderberry syrup. “Not only does this syrup taste fantastic, but elderberry supports immune function and is potent against many viral infections,” says Dr. Chasse.

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