Ear infections symptoms and treatment

The ear is made up of three parts: the outer ear, middle ear and inner ear.

Watch this short video to learn about ear infections in each part of the ear:

A middle ear infection (acute otitis media) is the most common type of ear infection, particularly in children. The infection causes inflammation in the middle ear and traps fluid behind the eardrum. Symptoms may include earache and a high temperature. Sometimes the eardrum may burst and release pus – often easing the pain. Eardrums usually heal once an ear infection runs its course.

There are three types of otitis media:

• Acute otitis media (AOM). This can occur abruptly and causes inflammation of the middle ear.
• Otitis media with effusion (OME) also known as ‘glue ear’. This can occur after another ear infection subsides and fluid remains trapped behind the eardrum. OME may show no symptoms but a GP will be able to diagnose the condition using an otoscope.
• Chronic otitis media with effusion (COME). This occurs when fluid remains in the middle ear for a longer period than 3 months or it is recurrent, even though there is no infection. COME can impair your hearing and make it harder to fight new infections.

An outer ear infection (otitis externa) is an infection of the ear canal, the tube that connects the ear opening to the eardrum. The infection causes inflammation of the skin of the ear canal, often causing swelling, redness and itchiness. Otitis externa (commonly known as ‘swimmer’s ear’) is usually bacterial and is prevalent among children and adults who swim regularly.

Otomycosis is a less common cause of otitis externa; it is a fungal ear infection that affects the outer ear canal. The infection is defined by coloured discharge from the ear. Other symptoms may include itching, ear pain and difficulty hearing. Classically a fungal infection would be more itchy than painful. Antifungal medication usually treats otomycosis, but a doctor will be able to determine the best treatment for your condition. Otomycosis is more common in tropical regions because fungi need warmth and moisture to grow.

For more information on otomycosis, read this comprehensive guide.

An inner ear infection causes inflammation of the labyrinth (labyrinthitis) or the vestibular nerve (vestibular neuronitis). Both infections are used to describe the same diagnosis, with symptoms including nausea and vertigo. Labyrinthitis results in hearing loss and sometimes tinnitus. In most cases, labyrinthitis may be caused by chronic ear infections or viruses.

Mastoiditis is a rare and serious bacterial infection affecting the mastoid bone behind the ear. The infection causes the air spaces (mastoid cells) in the mastoid bone to become inflamed. Symptoms may include redness, pain, tenderness and swelling behind the ear; alongside common symptoms of an ear infection including discharge from the ear, fever and possible hearing loss. In many cases, mastoiditis follows a persistent middle ear infection.

Important: You should see a doctor if:

• you or your child have mastoiditis symptoms
• you’ve had an ear infection that hasn’t cleared up with treatment
• you have new symptoms following a previous ear infection
• you’ve been diagnosed with mastoiditis and treatment hasn’t cleared the infection

Herpes Zoster (shingles) is an infection of the nerves caused by the varicella-zoster virus, the same virus that causes chickenpox. Unlike chickenpox, people get can repeated bouts of shingles. The infection is defined by a very painful red rash on the face or ear. Herpes Zoster can also paralyse facial muscles – this is known as Ramsay Hunt syndrome (RHS). You should see a GP right away if you think you have RHS.

Signs of a middle ear infection in adults include:

• earache
• slight hearing loss
• a sense of fullness in the ear
• a temperature
• nausea
• sometimes there can be drainage of pus from the ear

Earache symptoms can resolve if you get a hole in your eardrum (perforated eardrum) and pus comes out of the ear. This is often associated with hearing loss.

Outer ear infection symptoms can include:

• a red or swollen ear canal
• pain or discomfort in the ear
• dry skin or eczema in or around the ear canal
• itchiness in or around the ear
• discharge from the ear
• diminished hearing
• a sense of fullness in the ear

Labyrinthitis and vestibular neuronitis are both inner ear inflammations with subtle differences. Both infections can cause dizziness, but labyrinthitis also causes hearing loss. Symptoms can vary in severity, with most people experiencing a loss of balance. Common labyrinthitis symptoms include:

• vertigo (a feeling of spinning)
• feeling or being sick
• some hearing loss

Other labyrinthitis symptoms can include:

• mild headaches
• ear pain
• ringing in the ear (tinnitus)
• fluid or pus discharge from the ear
• blurred vision

Ear infection complications are rare but may include:

• tinnitus
• hearing loss
• perforated eardrum
• mastoiditis
• cholesteatoma
• necrotizing otitis externa
• problems with speech and language development (children)
• facial paralysis (very rare)
• meningitis (very rare)
• brain abscess (very rare)

You should see a doctor if:

• you experience labyrinthitis symptoms and don’t feel better after a few days or if symptoms begin to get worse
• persistent ear pain
• you have trouble hearing
• you have a perforated eardrum or drainage from the ear

Ear infection treatments depend on what part of the ear is infected.

Middle ear infection treatments can include:

• decongestants, nasal sprays, or antihistamines for allergy symptoms
• antibiotics for bacterial ear infections
• anti-inflammatory medication

Outer ear infection treatments can include:

• cleaning the ear regularly
• antimicrobial and anti-inflammatory medication – usually drops
• antibiotics occasionally if the infection is bacterial or antifungal if it is fungal

Inner ear infection treatments can include:

• resting and drinking plenty of fluids
• medication if symptoms are severe
• antibiotics to treat bacterial infections

Acidic ear drops can help to stop bacterial or fungal infections from spreading. You can get ear drops for an ear infection over the counter from your local pharmacy. If you have a perforated eardrum, consult with a doctor before using ear drops as they may get into the middle ear.

Your GP may prescribe antibiotic ear drops, antifungal ear drops, or ear drops containing corticosteroid if you have:

• an ear infection that shows no sign of improvement after a few days
• a serious health condition (like cystic fibrosis or congenital heart disease)

How to clear an ear infection with ear drops:

1. Remove any discharge from the outer ear using cotton wool
2. Warm up the bottle by holding it in your hand – cold ear drops can cause dizziness
3. Lie on your side (infected ear facing up)
4. Put the drops into the infected ear (follow dosage on the label)
5. Pull and push your outer ear to gently work the drops down your ear canal
6. Remain lying down for 5 minutes to prevent the drops from coming back out of the ear

Severe bacterial ear infections may require antibiotics. Amoxicillin (an antibiotic in the penicillin family) is usually prescribed on a 5-day course. Erythromycin or clarithromycin are alternative antibiotics if you’re allergic to penicillin.

Pain relief for adults can include:

• over-the-counter painkillers like paracetamol or ibuprofen
• a warm compression of the ear using a moist flannel or washcloth
• removal of discharge from the ear using cotton wool (do not use cotton buds)

Your doctor may prescribe antibiotic ear drops to treat chronic bacterial ear infections. In very rare cases, you may require surgery. This may be recommended when:

• you do not respond to other treatments
• the infection causes severe damage to the ear
• the infection causes hearing problems

Popping your ears (medically known as autoinflation) may relieve the feeling of fullness in your ears. Simply pinch your nose, close your mouth, and exhale very gently. This sends air through the tubes to help drain them. Autoinsufflation is a home remedy that can help alleviate built up pressure in the ear. A device called Otovent can be of help in these situations.

Tea tree oil is a natural remedy that may help with outer and middle ear infections. Tea tree oil contains terpinen-4-ol, a chemical compound that kills off bacteria. Although some studies have shown promising results, more research is needed to prove that essential oils help treat ear infections.

Olive oil is another essential oil that contains antibacterial properties. There is no scientific evidence to prove olive oil helps treat ear infections. However, the American Academy of Pediatrics says olive oil could be moderately effective on ear pain.

Garlic is another natural remedy used by some to treat ear infections. Some studies have shown that naturopathic ear drops containing garlic help with ear pain.

• Brandt-Daroff Exercise
• Half-Somersault or Foster Maneuver

If you have hearing loss or fullness in your ear then you should consult a doctor before flying as you might be at higher risk of an ear perforation and subsequent hearing loss. Earache may be worse after flying and it may take longer for pain to settle. You should speak with your doctor or surgeon before flying if you’ve previously had myringoplasty surgery.

Raise your head when sleeping to help drain fluid from the middle ear. You can do so by propping yourself up with two or more pillows – whichever is most comfortable for you.

In most cases, otitis media typically clears up within 3 to 5 days. After an ear infection subsides, fluid may remain in the middle ear. Otitis media with effusion (also known as glue ear) can cause temporary hearing loss and ear pain. Glue ear usually clears up on its own within 3 months.

Treatment can speed up glue ear recovery time. A doctor may suggest trying autoinflation, a technique that helps drain fluid from the ear. This can be done by blowing up a special balloon (Otovent) using one nostril at a time or swallowing while pinching your nostrils closed. This is typically done several times a day.

With treatment, otitis externa often clears up within a week. Many ear drop treatments involve a 7-day course taken several times a day. Always read the directions on the label and complete the full course to fully treat the infection.

Inner ear infections in adults usually clear up within a few weeks. During the first few days, labyrinthitis and vestibular neuronitis symptoms can be severe. They can significantly affect your quality of life and ability to carry out daily activities. In many cases, vertigo and sickness symptoms will gradually improve over the first few days. Over a few weeks, your hearing and balance should return.

It’s a common misconception that acute and chronic describe the severity of symptoms. Instead, they describe how long an infection lasts. Acute ear infections often come on suddenly and clear up within a week (this varies on the type of ear infection you may have). Chronic ear infections in adults cause ongoing symptoms and last for much longer.

Acute ear infections are single, isolated cases that clear up within an expected timeframe. Chronic ear infections in adults take longer to heal. If an ear infection keeps coming back, it is known as a recurring ear infection. This means the condition clears up but comes back constantly (3 times in 6 months, or 4 times in a year). You should see a doctor if you have a recurring ear infection.

Different types of ear infections are caused by different microorganisms:

• Otitis media often arises following a viral infection like a sore throat, the common cold, or the flu. Bacteria can also cause middle ear infections.
• Otitis externa is usually caused by bacteria (like Pseudomonas). Fungal infections and eczema can also cause swimmer’s ear.
• In most cases, vestibular neuronitis and labyrinthitis are caused by viruses. Bacterial inner ear infections are rare except in patients with pre-existing chronic ear diseases.

You can get a middle ear infection in one or both ears. When one ear is affected, it’s known as a single or unilateral ear infection. In some cases, the infection can move to the other ear through the Eustachian tubes. Symptoms are more severe and treatment can be more aggressive when both ears are infected. This is known as a bilateral ear infection. It is rare to get an outer or inner ear infection in both ears.

You’re more at risk of an ear infection if you:

• have upper respiratory tract infections (the infection can spread to the ear)
• have a narrow, blocked, or damaged ear canal (this can trap water in the ear making it easier for bacteria to grow)
• have a skin condition like eczema or psoriasis (inflamed skin can narrow the ear canal)
• are sensitive to chemical products like hair sprays or hair dyes (they can irritate your ear canal)
• use hearing aids or earplugs (they can introduce bacteria into the ear)
• live in a hot, humid climate (the warm environment makes it easier for bacteria and fungi to grow)
• have a weakened immune system (this reduces your ability to prevent infections)

You can keep getting ear infections if you:

• swim in polluted water (this can introduce bacteria into the ear)
• swim regularly (this can wash away earwax making it easier for bacteria to grow)
• don’t dry the ear properly after bathing or swimming (this can leave water in the ear making it easier for bacteria to grow)
• clean too much earwax from your ears (earwax helps protect the ear from infection)
• are overzealous when cleaning your ears (this can push wax into the ear making it easier for water to get trapped)

It’s difficult to prevent inner ear infections. However, you can reduce the risk of developing a middle or outer infection if you:

• wear a swimming hat over your ears when you swim
• avoid swimming in polluted water
• dry your ears well after swimming or bathing
• avoid using cotton buds to clean your ears
• avoid putting your fingers in your ears
• are quick to treat skin conditions like eczema or psoriasis
• manage your allergies well
• maintain good personal hygiene
• make sure you are up to date with vaccinations

Tips to prevent dizziness include:

• drink plenty of water to avoid dehydration
• turn the lights on if you get up at night
• take your time when getting out of bed
• be conscious to move your head slowly during regular activities
• avoid stressful situations – anxiety can exacerbate dizziness symptoms
• avoid alcohol
• avoid bright lights

Ear infection symptoms in toddlers can include:

• pulling or rubbing their ear
• a fever
• irritability and crying
• loss of appetite
• restlessness at night
• coughing
• loss of balance
• slight hearing loss
• fluid drainage from the ear

There a few signs to look out for that indicate your child is having hearing problems. Your child may:

• be inattentive
• be unresponsive to quiet sounds
• ask people to repeat what they say
• ask for louder TV or music volume
• speak more loudly or quieter than normal
• be difficult to understand

It can be difficult to know whether a young child has an ear infection because some of the signs of an ear infection are common behavioural traits. It’s important to know what ear infection symptoms in children warrant a visit to the doctor.

Children can develop the same complications from ear infections as adults. However, they are more at risk of permanent hearing loss from bacterial infections. Other complications include impaired speech development and behavioural problems.

Ear infections themselves are not contagious. However, the viruses, bacteria, and fungi that cause them are contagious. Good hygiene practices and hygiene education will help prevent the spread of infection.

Ear infection treatment for toddlers depends on the type of infection they may have. For:

• viral infections, antibiotics are not effective so a ‘wait-and-see’ approach is often used.
• bacterial infections, a doctor may prescribe your child with antibiotics.
• fungal infections, a doctor may prescribe antifungal ear drops. Fungal ear infections are uncommon in children.

To help manage the pain, young children can take over the counter medicine like paracetamol or ibuprofen at the recommended dose. Do not give both medicines at the same time – try one at first and if this doesn’t work you can try the other.

In some cases, hospital treatment may be required to treat glue ear in toddlers and young children. This may happen if:

• symptoms affect your child’s learning and development
• your child had severe hearing loss before developing glue ear
• your child has a cleft lip or Down’s syndrome

Treatment can include grommets (small temporary tubes placed into the ear to help drain fluid from the ear) or temporary hearing aids. Grommets fall out naturally within 6 to 12 months as the ear gets better. In some cases, adenoidectomy surgery may be recommended to remove the adenoid glands at the back of the nose.

Depending on the type of infection, ear infections usually get better on their own within:

• a few days (middle ear infection)
• a week (outer ear infection)
• a few weeks (inner ear infection)

Acute ear infections in toddlers are often painful at the start but clear up relatively quickly. Chronic ear infections in toddlers last for much longer and cause ongoing symptoms. You should see a GP if your toddler has a chronic or a recurring ear infection.

You should see a doctor if your child has:

• a fever
• ear pain that doesn’t begin to get better after three days
• swelling around the ear
• fluid draining from the ear
• a loss of hearing
• a severe sore throat
• dizziness
• episodes of being sick
• regular ear infections
• bilateral symptoms

You should see a GP if you suspect your child has an ear infection and they have a long-term health condition or a weakened immune system.

Ear infection symptoms in babies are not always clear as they can have similar signs to teething or illnesses like the common cold. Your baby may * have an ear infection if they:

• pull or rub at their ear
• have a high temperature or fever
• have difficulty feeding
• cry a lot or are irritable
• are restless at night
• have a cough
• do not react to some sounds
• have fluid draining from the ear

This photo shows a dull ear drum with inflammation. There is no perforation of the eardrum.

Infected ear piercing symptoms can include:

• redness and swelling around the piercing
• ongoing pain and tenderness
• yellow or green discharge
• itching or burning sensation
• a high temperature (fever)

Bacteria can grow around the piercing site, sometimes causing an abscess. If left untreated, this may need to be surgically drained and can leave scarring. Severe bacterial infections can lead to life-threatening complications like blood poisoning (sepsis) and toxic shock syndrome.

Doing your own piercing is dangerous. Bacteria can be introduced to the piercing site through unsterile piercing instruments or by touching the piercing with dirty hands. Self-piercing increases the risk of infection and scarring and should be avoided.

If you think your piercing may be infected you should see a GP immediately. Untreated ear piercing infections can cause serious complications. If you can’t get a same day GP appointment, visit your local walk in centre or see a doctor at a Medicspot walk in centre.

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Dr Sufian Ali is a Medicspot GP based in the West of Scotland, having attended Aberdeen Medical School and completed his GP training in Glasgow. He has enjoyed working in a number of specialties including paediatrics, psychiatry and emergency medicine; while also working in a variety of settings.

Professor Antony Narula is an otorhinolaryngologist (ENT surgeon). He practices general ENT and specialises in children with ear, nose and throat disorders and hearing problems. Antony was head of department at St Mary’s Hospital Paddington, Charing Cross Hospital, Hammersmith Hospital, and Leicester Royal Infirmary until he took early retirement in 2014 to concentrate on his medical charity work and private practice.

Notably, Antony was Past President of ENT UK and a Past President of British Society for Otology, The Association of Otolaryngologists and Young Consultant Otolaryngologists. He was also an Honorary Consultant at Chelsea & Westminster and Royal Brompton Hospitals. Recently Antony co-founded The Global Tracheostomy Collaborative, an organisation committed to improving care for all children and adults with tracheostomies.

Dr Maheinthan Yogeswaran qualified as a doctor from Aberdeen Medical School in 2007. He subsequently trained as a GP and now works as a GP for Medicspot alongside an NHS practice in Essex. He has a wide spectrum of experience; notably in palliative care. Dr Yogeswaran also works on training future generations of GPs as a GP trainer.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.