Ear infection

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 29, 2016
StartDiseasesEar infection

An ear infection is a complaint experienced by everyone at various points in their lives. For most, these infections are mild to moderate and they recover quickly. Others have chronic or recurrent infections that require more in-depth treatment from their doctors.


Definition & Facts

Types of ear infections include otitis media, otitis media with effusion, otitis externa, and labyrinthitis. Otitis media is an infection of the middle ear canal behind the ear drum. Otitis media with effusion is an infection with sticky, or thick fluid behind the ear drum. Otitis externa is an infection of the skin and tissues of the outer ear canal. Labyrinthitis is inflammation of the inner ear, usually due to a viral infection.

An ear infection is a painful condition that usually heals within a few days. Most of the swelling and irritation that occurs within the ear canal is the result of the body's natural immune response in fighting off the infection.

It is primarily children who get ear infections due to their Eustachian tube being narrower, shorter, and more horizontal than adults. This allows bacteria or viruses to enter more easily and become trapped whereupon they can multiply. Children's immune systems also take longer to identify pathogens and respond. Immunocompromised adults, such as those with diabetes, may also be more prone to ear infections.

Symptoms & Complaints

Both otitis externa and otitis media present with shared easily identifiable symptoms. Patients complain of pain in the ear, stuffiness, and sometimes, difficulty hearing. Other common symptoms include:

In otitis media, the ear drum is inflamed, may bulge slightly, be perforated, and ooze fluid. If the patient has otitis media and the ear drum bursts, there will be sudden extreme pain and a white, pus-like discharge mixed with blood. Only the most severe cases of otitis media lead to ear drum perforation.

In otitis externa, the ear canal may be red, inflamed, wet, and sloughing skin. Not all of these symptoms are present at once. Some patients can have otitis externa with only mild redness and inflammation.

Young children may become fussy, pull or scratch at their ears, and cry more often. When suffering from otitis externa, hearing loss may be a symptom among children. It is easier to identify symptoms of stuffiness and itchiness in adults with otitis externa. Sometimes, patients feel pain when pressing the outside front of their ear.


There are about five potential causes of an ear infection. These include: viral infection, bacterial infection, fungal infection, ear injury, or allergies. A bacterial infection is the most common cause of otitis externa. Both bacterial and viral infections are common in otitis media; some develop middle ear infections after a common cold or sinus infection which are typically caused by viral infections. The pathogen that caused the initial cold can make its way into the middle ear and grow within the moist environment.

Those with allergies develop nasal congestion, which involves blocked sinuses and can lead to inner ear infections. Otitis externa can also be caused when patients excessively remove ear wax, scratch their ears, or get water trapped in their ear canal.

Fungal infections are less common but shouldn't be overlooked if other prescribed treatment methods for viruses and bacteria fail. These are usually caused by Candida or Aspergillus. Several factors can make patients more prone to getting ear infections, such as:

Diagnosis & Tests

When patients visit the doctor, they answer some questions about their symptoms and the doctor will use an otoscope to look in their ears. This visual examination usually allows for diagnosis between otitis media and otitis externa.

Any discharge from the ear is sampled and tested to determine if the pathogen is bacterial or viral and the type. A specific laboratory test may be used to check for a fungal pathogen. Doctors may also examine the throat and sinuses to see if patients recently had a cold, allergies, or a sinus infection. The doctor can also use a pneumatic otoscope to determine how much fluid is behind the ear.

Other potential tests that patients are given include a blood glucose test to check for diabetes, a hearing test to check for hearing loss, and imaging studies to look for deeper infection or complications.

Treatment & Therapy

Doctors initially suggest treating the symptoms of an ear infection before moving onto antibiotics or other medications, unless it is severe.

If patients are diagnosed with bacterial otitis externa, they may be prescribed antibiotic ear drops. If otitis media persists for more than three days, the patient may be prescribed a five-to-seven day course of amoxicillin. Otitis media with effusion isn't usually treated with antibiotics as it usually occurs after a cold or sinus infection caused by an underlying viral infection.

Mild pain relievers, such as ibuprofen, can help with pain and ease some of the pressure from an ear infection. Topical corticosteroids may also be prescribed to help with itchy skin. Patients with chronic middle ear infections may be candidates for tube insertion in the ears. These tubes allow fluid and air to pass through the ear drum to prevent future infections.

Prevention & Prophylaxis

Avoiding the factors that increase likelihood of an ear infection, such as secondhand smoke, are a good method of prevention. Patients should also wash their hands frequently and stay current on their vaccinations to avoid the flu and other preventable diseases.

Those who are prone to developing otitis externa can avoid swimming or getting water into their ears. It is also a good idea to stop using cotton swabs, which disturb the protective layer of ear wax and scratch the ear canal.