Inner Ear Infection

Picture of the Anatomy of the Ear

An inner ear infection is technically an infection of the innermost part of the ear. Often, an inner ear infection is not an infection, but inflammation or irritation of the parts of the ear responsible for balance and hearing. Less commonly, an inner ear infection is a true infection caused by a virus or bacteria. When the inner ear is inflamed or irritated, symptoms such as dizziness, loss of balance, ringing in the ear (tinnitus), nausea, and vomiting may come on suddenly.

The ear anatomy is divided into three parts, the outer, middle, and inner ear.

1. The outer ear consists of the parts you can see outside the body, the auricle (also known as pinna), the earlobe, and the ear canal up to the eardrum.
2. The middle ear consists of the eardrum (tympanic membrane) and the auditory bones (ossicles) - the incus, malleus, and stapes.
3. The inner ear consists of the fluid-filled semicircular canals, snail-shaped cochlea, vestibular nerve, and auditory nerve.

Some people with an inner ear infection may have few or no symptoms at all. When symptoms do appear, they tend to come on rapidly. Symptoms of an inner ear infection may include:

• Dizziness or spinning sensation (vertigo)
• Nausea and vomiting
• Problems with balance or walking
• Hearing loss (or decrease in sound volume) in one ear
• Earache or ear pain
• Fever (sometimes)
• The feeling of fullness in the ear
• Ringing in the ear (tinnitus) or hearing abnormal sounds

The symptoms of inner ear infections are very similar to other inner ear disorders such as labyrinthitis and vestibular neuritis.

A viral infection is the most common cause of an inner ear infection. Viruses associated with inner ear infections include

• influenza,
• herpes viruses,
• Epstein-Barr virus, and
• polio.

Less frequently, a bacterial infection may cause an inner ear infection.

How long an ear infection lasts depends on how severe the infection is. When treated promptly, most inner ear infections will resolve in days to about 2 weeks duration, with no permanent damage to the ear. Some inner ear infections may lead to permanent partial or total hearing loss. There can also be damage to the vestibular system, which is responsible for balance, which may prolong the time for recovery.

Most ear infections that affect the outer or middle ear are mild and go away within one to two weeks. Inner ear disorders can last longer. Chronic ear infections can last 6 weeks or more.

The only way to know if you have an inner ear infection or another ear problem is to see a doctor. If you experience symptoms of an ear infection such as ear pain, nausea, vomiting, dizziness, spinning sensation, fullness in the ear, ringing in the ear, problems with balance or walking, or hearing loss, see a doctor.

A doctor will look into the ear with an instrument called an otoscope. An otoscope helps see inside the ear canal and eardrum to see if there is redness or swelling, build-up of earwax, or if there are any abnormalities in the ear. The doctor may gently puff air against the eardrum to see if it moves, which is normal. If it doesn't, this may indicate fluid buildup in the middle ear.

Inner ear infection symptoms such as dizziness and loss of balance can resemble other medical problems, so a doctor will rule out conditions that may cause the symptoms such as head injury, heart disease, stroke, side effects of medications, anxiety, and neurological disorders.

Other ways to tell if you have an inner or middle ear infection include:

• Most ear infections are infections of the middle ear (otitis media).
• Middle ear infections are commonly associated with upper respiratory infections (common cold), and a virus or bacteria may cause them.
• They are more common in children.
• Symptoms differ slightly from inner ear infections.
• Symptoms of middle ear infection include ear pain, fever, and ear discharge.
• Hearing reduction may also be noted with a middle ear infection. Since middle ear infections commonly occur with an upper respiratory infection (a "cold"), other symptoms of a middle ear infection include sinus pressure, sore throat, and runny nose.
• Nausea, vomiting, and dizziness usually are not symptoms of a middle ear infection.

Over-the-counter (OTC) and prescription medications may be used to treat symptoms associated with an inner ear infection.

Over-the-counter (OTC) medication

• Symptoms of nausea, vomiting, dizziness, and vertigo may be relieved with diphenhydramine (Benadryl).
• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be taken to relieve pain. Do not give children and teenagers aspirin as this has been linked with a serious condition called Reye's syndrome. AVOID: cold and cough medicines, especially in young children, as these can have dangerous side effects.

Prescription medication

• Steroids such as prednisone may help with inflammation.
• Antibiotics or antiviral medications to treat the infection
• Nausea may be controlled with:
  • meclizine (Antivert)
  • promethazine hydrochloride (Phenergan)
  • lorazepam (Ativan)
  • diazepam (Valium)
• If you become dehydrated from severe vomiting, you may need medical treatment with intravenous (IV) fluids.

Home remedies cannot treat or cure an inner ear infection, but they may help relieve ear pain and other symptoms.

• A warm compress may ease pain
• Standing or keeping your head upright while sitting can help drain the ear
• A saltwater gargle may help clear Eustachian tubes and soothe a sore throat.
• Do not smoke and limit alcohol intake
• Use stress management techniques to control emotional and psychological stress because it can worsen symptoms

Some natural remedies and alternative treatments are touted as treatments or cures for inner ear infections, including garlic oil or tea tree oil eardrops, apple cider vinegar, basil, olive oil, and hydrogen peroxide. Scientific studies do not show any of these to be effective.

Some chiropractors also claim to be able to treat inner ear infections with manipulation. There are currently no studies that show chiropractic to be effective.

Talk to your doctor before using any home remedies for an ear infection.

An inner ear infection itself is not contagious, but the viruses and bacteria that may cause them are. To prevent infection, practice good hygiene.

• Wash your hands frequently
• Avoid sharing food and drinks, especially with someone you know to have an ear infection
• Don't smoke and avoid secondhand smoke

Children should be vaccinated, specifically with the pneumococcal conjugate vaccine and the H. flu vaccine to protect against several types of pneumococcal and H. flu bacterial ear infections.