What Is an Ear Infection?
Illustration by Tara Anand for Verywell Health
Medically reviewed by John Carew, MD
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.
Illustration by Tara Anand for Verywell Health
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.
Otitis Media With Effusion
Otitis media with effusion (OME) is fluid collection in the middle ear without signs of infection. Usually, this occurs when the eustachian tubes (narrow tubes that connect your middle ears to your throat) are not working correctly, causing fluid and pressure to build.
Related: The Anatomy of the Ear
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
Fluid drainage
Hearing problems
Trouble sleeping
Outer Ear Infection
Outer ear infections may cause:
Ear drainage (a yellow or white liquid)
Hearing problems
Itching
Rash or flaking skin
Redness
Swelling
Acute vs. Chronic Ear Infections
Acute ear infections come on quickly and can cause significant ear pain. They involve fluid buildup behind the eardrum. Chronic ear infections last a long time (more than three months) or recur (come back) repeatedly over six months to a year.
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)
Related: Symptoms and Treatments for a Double Ear Infection
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.
Swimmer’s Ear
Swimmer's ear is an outer ear infection. It typically results from water that stays in the ear too long. The water may contain bacteria or provide a moist environment for bacteria to grow. You can get swimmer's ear after a bath, pool, hot tub, lake, pond, or the ocean.
The following are general risk factors for ear infections:
Exposure to tobacco smoke (including secondhand smoke)
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)
Antihistamines (allergy medications)
Pain relief ear drops
Related: Over-the-Counter Ear Drops: Types and Functions
Does Hydrogen Peroxide Help?
Putting a few drops of hydrogen peroxide in your ears can help soften or remove ear wax, which may help prevent middle or outer ear infections. If you or your child has a perforated (ruptured) eardrum, do not use ear drops (including hydrogen peroxide) unless you have instructions from a healthcare provider.
Related: 7 Home Remedies for Ear Infections
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.
Related:
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.
