Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 19, 2016

Otitis is a general term referring to an infection of the ear. Children tend to experience more ear infections than adults because the smaller size and horizontal angle of their Eustachian tubes make them more difficult to drain. If left untreated, ear infections can result in long-term complications, including hearing loss and speech delays or developmental delays.


Definition & Facts

Ear infections are typically classified according to the portion of the ear that is affected. An infection of the outer ear is called otitis externa. The condition is rarely serious and is most often seen in swimmers, individuals who live in hot and humid climates, and people who frequently wear headphones.

Otitis media is an infection of the middle ear, which is the space behind the eardrum housing the vibrating bones of the ear. A middle ear infection can lead to a painful buildup of fluid behind the eardrum. This can cause the tympanic membrane to rupture (perforated eardrum) and result in temporary hearing loss.

If untreated, it can even progress to the inner ear. An inner ear infection is known as labyrinthitis. The inner ear controls the vestibular system and houses the cochlea, which receives and deciphers sounds. An infection in this part of the ear significantly impacts a person’s sense of balance and ability to hear.

Symptoms & Complaints

The primary symptoms of an outer ear infection include redness, itching, and pain around the earlobes and external ear canal. The tissue around the ear may also become swollen and tender to the touch. There may also be foul-smelling pus drainage in the event of a bacterial infection or fungal infection.

The symptoms of a middle ear infection vary depending on the age of the patient. Children may become irritable and fussy, have difficulty sleeping, tug at their ears, run a fever, and have a loss of appetite.

Adults typically complain of ear pain, loss of hearing, and fluid draining from the ear. Children with inner ear infections usually show signs of irritability and discomfort, such as crying and pulling at their ears. Adults and children may also experience symptoms of vertigo, including dizziness and nausea


Outer ear infections typically occur when water or other liquids become trapped in the ear canal, which provides an ideal breeding environment for bacteria or fungi. Middle ear infections are normally the result of bacterial or viral infections. These infections often occur when an illness, such as a common cold, flu, or allergies, causes swelling and congestion in the throat, nasal passages, and Eustachian tubes.

Inner ear infections are most often caused by bacterial or viral infections. Labyrinthitis can produce or coincide with a number of complications, including meningitis, upper respiratory tract infections, and hearing loss. 

Diagnosis & Tests

In many cases, a doctor can identify an outer ear infection by examining the ear with an otoscope. The doctor may tug at the earlobe gently or push on the ear flap in front of the ear canal to see if the patient experiences pain. If so, then the infection is most likely external. To diagnose a middle ear infection, the doctor will use the otoscope to look for signs of inflammation or fluid buildup in the ears, nose, and nasal passages. In most cases, there will be fluid behind the tympanic membrane, or it will appear red or bulging.

Diagnosing an inner ear infection can be more of a challenge since the symptoms can mimic a number of other medical problems. Laboratory and imaging tests are often required to rule out other potential causes of dizziness, including neurological disorders, cardiovascular disease, traumatic head injuries, and stroke

Treatment & Therapy

Most outer ear infections are treated with ear drops containing a combination of medications, including corticosteroids to reduce inflammation, an antibiotic or antifungal preparation, and an acidic solution to alter the pH of the ear canal so that it is less favorable to bacteria. Over-the-counter pain relievers, such as ibuprofen, acetaminophen, or naproxen, can help alleviate any discomfort associated with the infection.

Some middle ear infections resolve on their own without medications. A wait-and-see approach is often recommended in children whose symptoms have lasted less than 48 hours and who are running a temperature below 102.2°F (39°C).

Antibiotics are the standard treatment for ear infections in children less than six months old or whose symptoms do not resolve in 48 hours. Children experiencing recurrent cases of otitis media may benefit from a myringotomy, which involves inserting tubes into the eardrums to allow fluid to drain.

Inner ear infections resulting from bacterial infections are treated with antibiotics. Severe infections may require hospitalization and surgery to drain the fluid from the ear. Viral infections typically have to run their course. Medications may also be prescribed to help control episodes of nausea and dizziness. Recovery from an inner ear infection can take several weeks to several months depending on the severity. 

Prevention & Prophylaxis

The following tips can lower the risk of developing an ear infection:

  • Preventing the spread of germs—Washing the hands frequently and thoroughly and not sharing eating and drinking utensils will reduce the likelihood of contracting colds or other illnesses that can open the door for an ear infection.
  • Breastfeeding infants—Infants should be breastfed for at least six months whenever possible. Breast milk contains vital antibodies that help build the baby’s immune system and offer protection against ear infections and other illnesses.
  • Bottle feeding babies in an upright position—Using the proper position to feed a baby will prevent fluid from accidentally backing up into the middle ear that can cause an infection. 
  • Getting vaccinated—Parents should talk to their doctor about age-appropriate vaccinations for their children. Flu vaccines and pneumococcal vaccines may help prevent illnesses that can lead to ear infections.
  • Drying one's ears after showering or swimming—One way to do this is to use a hair dryer on the lowest setting.
  • Protecting ears when swimming—The best way to do this is to wear a swim cap or to treat the ears with drops containing alcohol or acetic acid after swimming.
  • Using garlic oil—Garlic oil has anti-microbial properties, and a few drops of the warm oil in the ears can be soothing and help fight the infection.
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