What is an ear infection?
Ear infections can be caused by viruses, bacteria, or rarely yeast. There are three areas in the ear where ear infections can occur in adults and children.
- Outer ear infections (swimmer's ear): An outer ear infection (otitis externa) most commonly experienced is often known as “swimmer’s ear.” This infection usually is due to bacterial infection of the skin tissue covering the ear canal. Excessive immersion in water or injuring the ear canal by putting things in it (such as using cotton swabs in the canal to remove earwax) makes you more likely to develop an outer ear infection.
- Middle ear infections: A middle ear infection (otitis media) is an infection just behind the eardrum (tympanic membrane) with pus trapped in the adjacent hollow cavity (middle ear space) of the facial bone. Middle ear infections frequently are a complication of the common cold in children. Most middle ear infections are caused by viruses and will resolve spontaneously. Bacterial infections cause some middle ear infections, which requires antibiotic treatment.
- Inner ear infections: Inner ear infections are very rare, and usually are caused by a virus. These “infections” are more accurately characterized as inflammation of the structures of the inner ear (labyrinthitis). Since these structures affect hearing and balance, inner ear infections cause symptoms such as ringing of the ears (tinnitus) or dizziness and balance disruption (vertigo). Usually, inner ear infections in adults and children (rare) need medical treatment.
Which parts of the ear can become infected?
There are three separate elements of the human ear that anatomically and functionally work together to enable hearing and interpretation of sounds as well as provide a sense of body position and balance during movements of the head and body.
- The outer ear includes the cartilaginous structure (pinna) and ear canal ending at the eardrum (tympanic membrane).
- The middle ear is composed of the eardrum and a small hollow area of the facial bone adjacent to the eardrum in which three small bones are linked together. The eardrum moves as a result of air pressure waves that are focused by the pinna and travel down the ear canal. Movement of the tympanic membrane causes a domino like movement of these three small bones that ultimately transfer this stimulus to the inner ear.
- The inner ear has two structures.
- The cochlea, which converts movements of the ear bones into nerve impulses that are sent to the brain, which then are “translated” into sounds.
- The semicircular canals (part of a separate structure), has three parts that interpret motion of the head allowing recognition of your position in space (for example, lying down, bending over, etc.)
Picture of the Outer, Middle, and Inner Ear Structures
Swimmer's Ear (Outer Ear Infection) Symptoms
Swimmer's ear (outer ear infection or external otitis) usually is caused by bacteria. Symptoms of swimmer's ear include ear pain and drainage, itchy ears, a feeling of fullness in the ear, and redness and inflammation of the outer ear.
What are the signs and symptoms of an ear infection?
Common outer (swimmer's ear) and middle ear infection symptoms and signs
- Mild to severe ear pain
- Problems hearing
- Redness and inflammation
- Pus draining from the ear
Other swimmer's ear symptoms and signs
Middle and inner ear infection symptoms and signs
- Problems with balance
- Feeling of fullness in the ear
Other inner ear infection symptoms and signs
Can I treat an ear infection at home?
You can treat some outer and middle ear infections at home with remedies and over-the-counter medication for symptoms like pain and inflammation.
Swimmer’s ear (outer ear infection) home treatment
Usually, prolonged and recurrent immersion in water causes outer ear infections. The primary treatment for swimmer’s ear is to avoid getting water in the ear canal until the ear pain is gone.
An outer ear infection may take several days to heal, but the pain usually is gone within one week. Moreover, the warmer the water, the higher the likelihood of getting swimmer’s ear, for example, people who swim in the summer are more likely to develop an outer ear infection than wintertime surfers.
Middle ear infection home treatment
Numerous studies have shown that viruses cause middle ear infections. Pain management for ear pain for two or three days will allow the body’s natural immune system to fight and cure the infection, much like the common cold. However, some people with middle ear infections may need to see a doctor or other health-care professional for medical treatment.
Inner ear infection and labyrinthitis home treatment
Inner ear infections and labyrinthitis (inner ear inflammation adults and children are very rare, moreover, the symptoms of inner ear infections may be associated with other non-infectious causes, otolaryngologists (doctors that specialize in ear, nose problems) usually treat inner ear infections in adults and children.
What home remedies relieve ear pain and cure ear infections?
Natural and over-the-counter (OTC) nonprescription (not antibiotic) remedies for ear infections
- Over the counter pain relievers, for example, acetaminophen (Tylenol and others) and ibuprofen (Advil). Those over 18 years of age can also consider aspirin for pain. Those younger than 18 should avoid aspirin due to its association with Reye's syndrome (a potentially fatal disease associated with liver and brain deterioration).
- For ear pain associated with a middle ear infection without an eardrum perforation, warm (not hot) oil (olive, vegetable) dripped gently into the ear canal and held in place by a cotton ball may help ease ear pain. Warm oil is less likely to be helpful for swimmer’s ear.
- A warm or cold compress may help ear pain. Some people find alternating between a warm and cold compress helpful
- Naturopathic eardrops have been tried in an effort to control ear pain and the primary ear infection with limited success. Naturopathic eardrops have not been approved by the FDA
- Tea tree oil eardrops are widely used but have the same limitations discussed with regard to naturopathic eardrops.
- An oil containing ginger may be applied to the pinna. Advocates of this preparation urge avoiding pouring ginger oil into the ear canal.
- Anecdotal testimonies exist praising the use of garlic oil poured into the ear canal as an effective therapy for outer and middle ear infections.
- Parents of young children with middle ear infections (otitis media) have long since noted the reluctance to put pressure on the side of the infected ear. Sleeping with the painful side “up” may be of help in the management of ear pain.
- Prior to antibiotics, a common “natural” technique to treat middle ear infections was for the doctor to make a small incision in the eardrum (myringotomy) to relieve pressure and allow any pus to drain from the ear.
- Myringotomy is still considered when treating unusual bacterial ear infections in newborns, infants, and those with a compromised immune system and that may require antibiotics not commonly used to treat ear infections.
- Chiropractic treatment has been used to treat and cure middle ear infections; however, comparative studies have mixed results. Chiropractic treatment to treat and cure ear these infections may increase the risk of injury.
Quick GuideTinnitus: Why Are My Ears Ringing?
Should ear infections be treated with antibiotics?
Antibiotics and outer ear infections
- The most recent policy statement by the American Academy of Pediatrics (AAP) encourages pain management and not antibiotics as the initial approach to most outer and middle ear infections. Since outer ear infections (swimmer’s ear) are generally bacterial in cause, this type of ear infection can be prevented by avoiding prolonged ear canal immersion.
- Antibiotic eardrops have been shown to accelerate the healing process in swimmer’s ear, but avoiding prolonged water in the ear canal also is highly recommended. Rarely, severe cases of swimmer’s ear will cause the ear canal tissue become swollen shut. To treat this, an "ear wick" is placed in the ear to allow the antibiotic eardrops into the narrowed ear canal. Oral antibiotics often are used in severe cases.
Antibiotics and middle ear infections
- AAP guidelines for middle ear infection (otitis media) recommend first line use of antibiotics (in lieu of purely pain management) in children younger than 2 years of age experiencing moderate to severe ear pain and fever greater than 102.2. F (39 C). This recommendation reflects the knowledge that this age group is much more likely to have a bacterial cause of a middle ear infection versus a viral cause in children above two years of age.
- Children between 6 months to 2 years of age who are not having severe pain and do not have a temperature greater than 102.2 are candidates for parental monitoring without antibiotics.
- Children older than two years of age should be monitored.
- Regardless of therapy type (observation or antibiotics), it is important that parents or caregivers have access to medical follow up should symptoms worsen.
Antibiotics and inner ear infections
- Inner ear infections are rare, and usually need to be treated by an Ear, Nose, and Throat specialist.
If you have an ear infection in which antibiotics are not prescribed, follow up for re-evaluation by the doctor is important.
When to call the doctor for an ear infection
Some symptoms of an inner ear infection can be the same as a stroke. If you have vomiting, headache, vision changes, fever, weakness in one side of your body, slurred speech or are unable to walk, seek medical care right away.
Infections involving high fever, discharge or bleeding from the ear canal, headache, vomiting, dizziness, loss of hearing, or severe pain should be seen by a doctor. A doctor should see most people with an inner ear infection.
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Medically Reviewed on 1/25/2018
Jose Rosa-Oliveras, et. al. Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practioner. Pediatrics in Review. November 2016, 36 (11), 480-488.
Lieberthal, AS, et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics. March 2013. Vol:131/Issue 3.