Medically ReviewedThe ear, which consists of the outer, middle, and inner parts, can become infected by bacteria, fungi, or viruses in the ear canal or eustachian tube, affecting its ability to transmit and process sound.
More than 80 percent of children experience at least one episode of otitis media or middle ear infection by the time they are 3 years old. While specific data on adult ear infections is less comprehensive, they are a leading cause of health care visits across all age groups.
Ear infections are classified into three types based on location: outer, middle, and inner ear. The Epoch Times/Shutterstock
What Are the Types of Ear Infections?
The three parts of the ear are the visible outer ear and ear canal; the middle ear, which houses tiny bones that amplify sound; and the inner ear, which converts sound into electrical signals for the brain.
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The main types of ear infections include:
1. External ear infection: Also known as otitis externa or swimmer’s ear, this condition is an infection or inflammation of the external ear canal caused by bacteria or fungi—often due to trapped water promoting their growth. Otitis externa can be short-term, lasting less than six weeks, or long-term, persisting for more than three months. Approximately 10 percent of people experience otitis externa in their lifetime, with 95 percent of cases being acute.
2. Middle ear infection: The term “ear infection,” typically refers to a middle ear infection, also known as otitis media, which is usually caused by viruses or bacteria. It is more common in children than adults and is a leading reason for children’s visits to the doctor. There are three main types of middle ear infections:
- Acute otitis media: Signs and symptoms of infection lasting up to six weeks
- Subacute otitis media: Symptoms lasting between six weeks and three months
- Otitis media with effusion: Fluid in the middle ear without signs and symptoms of infection
Less Common Types of Ear Infections
Besides the three main types of middle ear infections, other forms can occur. These include:Infectious myringitis: An infection-induced inflammation of the eardrum, which serves as the boundary between the outer ear and the middle ear. It causes painful blisters on the eardrum, and bacterial infections may include fever.
Herpes zoster of the ear: A viral infection of the cochlear and facial nerves caused by the varicella-zoster virus. It can cause ear pain, vertigo, facial paralysis, and blisters on the ear, face, or neck.
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What Causes Ear Infections?
Ear infections can arise from multiple sources, with bacterial and viral pathogens playing significant roles in their development. Bacterial infections are especially complex, as different strains can affect various regions of the ear and lead to distinct types of infections.
Viral infections may directly cause ear infections or create conditions that make the ear more vulnerable to secondary bacterial infections.
Additionally, upper respiratory infections frequently contribute to ear problems, as they can spread directly to the ear or cause generalized inflammation that increases the risk of complications.
Causes by Specific Infection Types
The underlying cause of an ear infection often depends on which part of the ear is affected. Each type of ear infection has its own set of triggers—ranging from bacteria and viruses to structural issues or immune responses.Story continues below advertisement
Otitis externa
- Bacterial overgrowth: Most commonly caused by Pseudomonas aeruginosa or Staphylococcus aureus, especially in moist environments.
- Fungal presence: Species like Candida and Aspergillus can sometimes grow in the ear canal, often after prolonged moisture exposure or antibiotic use.
- Ear canal trauma: Scratching, use of cotton swabs, or inserting foreign objects can damage the skin and allow pathogens to enter.
- Obstructed ear canal: Earwax buildup can trap moisture and create a breeding ground for microbes.
- Eustachian tube dysfunction: Blocked or poorly functioning tubes prevent fluid from draining properly, allowing pathogens to multiply.
- Bacterial infection: Often caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Enlarged or infected adenoids: Can block the eustachian tubes and harbor bacteria.
- Mucus overproduction: Can lead to fluid accumulation behind the eardrum, especially in teething infants.
- Viral or bacterial invasion: Infections such as maternal rubella, cytomegalovirus (in newborns), or complications from bacterial meningitis may reach the inner ear.
- Autoimmune response: Conditions like polyarteritis nodosa and granulomatosis with polyangiitis can trigger inflammation in the inner ear structures.
- Vestibular nerve involvement: Viruses affecting the vestibular nerve can lead to inner ear inflammation and disrupt balance.
Risk Factors
People may face an increased likelihood of developing ear infections due to several key risk factors. Those with compromised immune systems—whether from underlying medical conditions, ongoing treatments, or advanced age—are particularly vulnerable to ear infections.Environmental factors also play a critical role, with exposure to tobacco smoke emerging as a significant contributor. Tobacco smoke can cause inflammation and increase susceptibility to infection.
A personal medical history of previous ear infections can further compound risk, as prior ear problems often indicate increased biological vulnerability to future complications.
Allergic disorders also contribute, potentially triggering inflammation and fluid accumulation, which create favorable conditions for infection to develop.
Unique Risk Factors by Infection Type
Otitis externa- Swimming: Especially in contaminated water, which introduces bacteria into the ear canal (associated with a fivefold increase in risk).
- Humidity: Warm, moist environments promote bacterial and fungal growth in the ear canal.
- Narrow ear canals: Reduced airflow and drainage can lead to moisture buildup.
- Chronic conditions: Skin issues such as diabetes, eczema, and dermatitis can impair the ear’s natural defenses.
- Hearing aid use: Devices may cause irritation and trap moisture in the ear canal.
- Chemical irritants: Shampoos, hair products, and certain ear care items can disrupt the skin barrier or cause inflammation.
- Age: Children between 6 and 12 months have smaller, more horizontal eustachian tubes, making them more prone to fluid buildup and infection.
- Premature birth: Babies born before 37 weeks of gestation may have underdeveloped ear structures and immune defenses.
- Sex: Otitis media is slightly more common in boys and men.
- Bottle feeding: Drinking from a sippy cup or bottle while lying down may have milk allow fluid to enter the eustachian tube.
- Lack of breastfeeding: Breast milk contains protective antibodies, so not breastfeeding may reduce children’s natural defenses.
- Pacifier use: Linked to increased pressure changes and bacterial transfer in the middle ear.
- Daycare attendance: Raises exposure to viruses and bacteria, especially in group care settings.
- Cleft palate: Can disrupt normal eustachian tube function and drainage.
- Down syndrome: Often associated with structural and immune differences that affect ear health.
Indigenous heritage: Children of First Nations and Inuit descent face higher risk, though the reasons are not fully understood.- Family history: A strong genetic component may influence susceptibility.
- Recent viral respiratory infection: Colds and other illnesses can lead to inflammation and fluid buildup in the middle ear.
- Age: Viral labyrinthitis is most common in adults between 30 to 60, while bacterial cases more often affect children under 2.
- Viral history: Prior infections such as herpes, measles, mumps, polio, hepatitis, Epstein-Barr virus, or varicella may contribute.
- Excessive alcohol use: Linked to inner ear inflammation, particularly in cases of labyrinthitis.
- Chronic otitis media: Long-standing middle ear problems can progress to inner ear involvement.
What Are the Symptoms and Signs of Ear Infections?
Ear infections, regardless of their specific type, often manifest through consistent symptoms. Patients typically report a range of uncomfortable sensations, with ear pain and pressure being the most prominent indicators.
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Many also experience a feeling of fullness inside the ear, along with noticeably reduced hearing, which may be described as muffled or partially lost.
In addition to localized symptoms, a fever is a frequent systemic response, signaling the immune system’s attempt to combat the invading pathogens.
Unique Symptoms by Condition
- Otitis externa:
- Tenderness when touching the tragus or pinna
- Itching or irritation in and around the ear canal
- Redness and swelling of the outer ear or ear canal
- Flaky or peeling skin around the ear canal
- Swollen or sore glands in the neck or throat
- Pain that worsens while chewing
- A squelching or popping sensation when moving the ear or jaw
- Otitis media:
- Nasal congestion
- Cough
- Lethargy or low energy
- Vomiting
- Loss of appetite
- Fluid drainage or a ruptured eardrum
- Otitis interna:
- Vertigo or a sensation of dizziness or the room spinning
- Difficulty maintaining balance
- Nausea and vomiting
- Ringing or buzzing in one or both ears
- Involuntary, rapid eye movements
- Mild headaches
Unique Symptoms in Infants and Young Children
In infants, the most common sign of an ear infection is persistent irritability or crying that can’t be soothed, often accompanied by a fever and difficulty sleeping.Younger children may show symptoms such as fussiness, trouble sleeping, tugging or pulling at their ears, and difficulty hearing quiet sounds.
How Are Ear Infections Diagnosed?
Health care professionals diagnose ear infections through a comprehensive and methodical process that starts with a thorough review of the patient’s medical history. This includes an evaluation of current symptoms and past health issues to establish context and identify potential risk factors.
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Following the medical history review, a physical examination is conducted to assess the ears and surrounding areas.
The cornerstone of this diagnostic approach is otoscopy—a specialized technique using a lighted instrument called an otoscope to inspect the ear canal and eardrum. This allows doctors to directly visualize any signs of inflammation, fluid accumulation, or structural abnormalities that might indicate an infection.
Type-Specific Diagnostic Approaches
Otitis externaDiagnosis is based on visible inflammation in the ear canal, especially when the tragus or pinna is tender. In some cases, if the infection is recurrent or the patient is immunocompromised, a drainage sample may be collected to identify bacterial or fungal causes.
Otitis media
Doctors look for a bulging or inflamed eardrum or fluid behind it. Hearing tests may be used in patients with a history of infections. Tympanometry and tympanocentesis help assess middle ear pressure and fluid. Infants under 12 weeks with fever may need a full sepsis workup.
Otitis internaStory continues below advertisement
Diagnosis is made by ruling out other conditions. It’s based on symptoms, history, and a physical exam. Imaging such as MRI or CT may be used to exclude stroke or structural problems.
What Are the Possible Complications of Ear Infections?
Ear infections, if left untreated or in severe cases, can potentially lead to a range of serious and life-altering complications.
The most immediate risk involves hearing. Patients may experience partial or complete hearing loss or develop persistent tinnitus—a condition characterized by chronic ringing or buzzing in the ears.
In more extreme scenarios, ear infections may trigger neurological complications. Facial nerve paralysis can impair muscle control, resulting in both cosmetic and functional challenges.
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Untreated infections can also spread to the central nervous system, potentially leading to severe conditions like bacterial meningitis—a dangerous inflammation of the protective membranes surrounding the brain and spinal cord. Another serious risk is a brain abscess, where a localized infection forms a pocket of pus within brain tissue.
Additionally, some patients may develop labyrinthitis, an inflammation of the inner ear structure responsible for balance. This can cause vertigo, dizziness, and significant balance disruptions.
Complications by Infection Type
- Outer ear complications:
- Malignant otitis externa: A life-threatening infection typically affecting older adults with diabetes or immunocompromised patients
- Auricular or periauricular cellulitis: Bacterial infection of the skin and tissues around the outer ear
- Perichondritis: Infection of the cartilage in the outer ear
- Myringitis: Inflammation of the eardrum
- Facial cellulitis: Bacterial skin infection affecting the face
- Osteomyelitis of the temporal bone: A serious bone infection that can spread from the ear
- Middle ear complications
- Serous otitis media: Persistent fluid buildup without infection
- Eardrum perforation: Acute and chronic tearing of the eardrum
- Cholesteatoma: Abnormal skin growth in the middle ear
- Tympanosclerosis: Scarring or calcification of the eardrum
- Petrositis: Infection of the temporal bone; rare but sometimes fatal
- Cholesterol granuloma: Cyst-like lesion at the skull base near the middle ear
- Infectious eczematoid dermatitis: Inflammatory skin condition affecting the ear canal
- Subdural empyema: Collection of pus between the brain and its outer membrane
- Extradural abscess: Infection between the skull and the brain’s outer covering
- Otitic hydrocephalus: Increased intracranial pressure related to chronic middle ear infection
- Inner ear complications
Bilateral vestibular hypofunction: A severe condition often caused by bacterial meningitis. It can lead to blurred vision during movement (oscillopsia) and problems with balance and spatial awareness.
Labyrinthitis ossificans: This is when the inner ear structures harden as they gradually turn to bone, potentially leading to permanent hearing or balance loss.
Vestibular neuritis complications include:Benign paroxysmal positional vertigo: This condition affects 10 to 15 percent of patients within a few weeks of onset.
Persistent postural-perceptual dizziness: A form of chronic, nonspinning vertigo and unsteadiness that affects up to 25 percent of those diagnosed.
What Are the Treatments for Ear Infections?
Treatment approaches for ear infections involve a multifaceted approach designed to alleviate symptoms, support the body’s natural healing process, and prevent potential complications.
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Pain management is a key component of early treatment. Over-the-counter pain relievers are commonly recommended to ease discomfort across various types and severities of infection.
Ear hygiene is also important, particularly for outer ear infections. Doctors often advise keeping the ear dry, as moisture can worsen symptoms and delay healing.
Some cases may be managed with a watchful waiting approach, giving the immune system two to three days to fight the infection without medical intervention. While this is more common in some countries, it’s less widely practiced in the United States, where more proactive treatment is often preferred.
Antibiotics may be necessary for severe or persistent ear infections. The specific selection and administration of these medications vary depending on the type and location of the infection.
Treatments by Infection Type
Otitis externaThis condition can sometimes improve by itself, but with proper treatment, it typically clears within 7 to 10 days. Treatment options include:
- Corticosteroid ear drops: Helps reduce inflammation
- Topical antibiotic ear drops: Commonly prescribed; oral antibiotics are rarely needed
- Acetic acid (vinegar) ear drops: Create an acidic environment that inhibits bacterial growth
- Warm compress: Applying a warm cloth to the ear may help if a boil is present
- Professional ear cleaning: Recommended in cases of acute otitis externa
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Middle ear infections usually resolve on their own within two to three days, though fluid may remain in the middle ear after symptoms improve.
- Homecare: Apply a warm cloth to the affected ear, stay hydrated, and avoid allergens such as dust
- Observation (watchful waiting): Often recommended with close follow-up
- Oral antibiotics: Prescribed based on clinical guidelines, especially in more severe or prolonged cases
- Myringotomy: A small surgical incision in the eardrum may be considered in cases of significant pain, fever, or persistent symptoms—though this is rarely performed
- Adenoid removal surgery: Enlarged adenoids contributing to recurring ear infections may be removed; however, tonsil removal does not help prevent ear infections
Labyrinthitis and vestibular neuritis usually go away on their own, but recovery can take several weeks.
- Labyrinthitis treatment: Depends on the cause and may include rest, hydration, antiviral medications, corticosteroids, or immunomodulators such as azathioprine, etanercept, or cyclophosphamide
- Symptom relief: Short courses of benzodiazepines or antihistamines may reduce vertigo; antiemetics like prochlorperazine can ease nausea
- Antibiotics: Rarely used unless a bacterial cause is confirmed
- Surgery: Considered in a small number of cases
- Physical therapy: Vestibular rehabilitation may help the brain adapt to changes in balance signals
How Does Mindset Affect Ear Infections?
While mindset doesn’t directly cause or cure ear infections, it can influence how symptoms are managed and how a person copes with the condition.
A positive outlook may support immune function, reduce stress, and improve pain tolerance, potentially aiding recovery.
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People with an optimistic mindset are more likely to adhere to treatment plans, which can contribute to better outcomes.
What Are the Natural Approaches to Ear Infections?
It’s important to consult a health care provider before trying any natural remedies for ear infections, especially when symptoms are moderate to severe or persistent.
Herbal Medicines
Herbal remedies like Sinupret and mullein have traditionally been used to support upper respiratory and ear health. Sinupret is a German formula made from plant extracts such as sorrel, European elder, cowslip, European vervain, and gentian root. It may help relieve sinus congestion, which can indirectly reduce ear pressure and discomfort.
Mullein (Verbascum), commonly used in Spanish folk medicine, has a long history of use for earaches and ear infections. While both remedies are widely used in traditional practice, scientific evidence supporting their effectiveness remains limited.
Propolis-Based Products
Propolis, a resin-like compound produced by bees, has demonstrated antibacterial, antiviral, and anti-inflammatory properties. In one Italian study, children with acute otitis media were treated with a propolis-based supplement called Propolisina for 72 hours. Researchers found that the supplement reduced symptom severity and the need for anti-inflammatory medications, suggesting it may be a helpful add-on therapy during the watchful waiting period.Homeopathy
An Israeli study found that Otikon—a naturopathic ear drop made with garlic, mullein, calendula, and St. John’s wort in olive oil—was as effective as anesthetic ear drops in managing ear pain associated with acute otitis media in children and teens.Vitamin D Supplements
Low vitamin D levels have been linked to increased risk of ear, nose, and throat (ENT) infections. A 2022 meta-analysis found that vitamin D supplementation improved outcomes in people with ENT-related conditions, including ear infections. A 2019 review also suggested that vitamin D may reduce the risk of acute otitis media, although it did not prevent pus formation.Xylitol Products
Xylitol, a naturally occurring sugar substance found in fruits and vegetables, may support immune function and help prevent ear infections. Research has found that xylitol supplementation and nasal sprays may reduce the risk of otitis media in children. One preliminary study found that although xylitol-gum chewing did not significantly improve the overall resolution rate of otitis media, it might shorten recovery time with only minor side effects reported.How Can I Prevent Ear Infections?
To protect your ears and reduce the risk of infections, you can:
- Avoid scratching the inside of your ears or inserting objects like cotton swabs
- Keep ears clean and dry, especially while showering or bathing
- Avoid swimming in dirty or polluted water
- After getting wet, dry your ears thoroughly by tilting your head to drain excess water or using a hairdryer on low heat and lowest speed setting at least a foot away from the ear
- Use earplugs when swimming, particularly in pools or lakes with questionable water quality
- Consider using a mixture of rubbing alcohol and white vinegar after swimming to help prevent bacterial growth. Consult a health care provider for proper preparation, dosage, and application
- Avoid smoking and exposure to secondhand smoke
- Wash hands frequently—yours, theirs, and their toys—to limit the spread of germs
- If possible, breastfeed infants and avoid bottle-feeding while they are lying down
- Transition from a bottle to a cup by age one, and never put them to bed with a bottle
- Reduce pacifier use after six months, as prolonged use may increase the risk of infection
- Keep children away from secondhand smoke
- Choose smaller daycare settings, when possible, to minimize exposure to infections
- Protect their ears by keeping them dry when swimming by using earplugs or a bathing cap
- Treat underlying ear-related conditions such as eczema or allergies
- Limit their contact with sick children when possible
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