Ear infections are conditions that affect the outer, middle or inner ear. They most often result from viral, fungal or bacterial infection. While most ear infections clear on their own, some require antibiotics. If left untreated, bacterial ear infections can cause serious complications, especially for young children.

There are several different types of ear infections. These include:

• Otitis media. Results from inflammation and fluid buildup in the middle ear. If enough bacteria grow in the area, the fluid may become infected. Otitis media is the most common type of ear infection in young children and often occurs after a cold or a bout of the flu.
  
  
• Otitis externa. Also called swimmer’s ear or external otitis, it involves inflammation, irritation or infection of the ear canal (passageway that carries sound from outside the body to the eardrum) and/or outer ear (the visible part of the ear, including the earlobe). Despite its nickname, it can occur without swimming. Microorganisms typically enter a cut in the skin inside the ear canal or anywhere on the outer ear.
  
  
• Labyrinthitis. Infection of the inner ear that affects balance and hearing. It is rare and may occur in two different forms:
  
  
• Viral labyrinthitis. Inner ear infection caused by viruses (e.g., viruses that cause the measles, mumps or flu). Viral labyrinthitis usually resolves on its own, without treatment, and leaves no long-term complications.
  
  
• Bacterial labyrinthitis. Inner ear infection caused by bacteria, such as when a middle ear infection (otitis media) spreads to the inner ear, or as the result of the spread of meningitis (inflammation of the protective cover of the brain and spinal cord).

Most cases of ear infections occur among children and occur after a bout with a cold, the flu or flare-up of allergies. Other factors that may increase the risk of ear infections include ear piercings, having foreign objects stuck in the ear canal, physical injuries to the outer ear and use of irritating chemicals (e.g., hair spray, hair dye) near the ear.

Signs and symptoms of ear infections may differ, depending on the location and cause of the problem. Ear infections may include an earache or other ear discomfort, hearing loss (usually temporary), drainage from the ear, nausea and vomiting.

In diagnosing an ear infection, a physician will pay special attention to the throat, sinuses, head, neck and lungs. A physician will likely ask about any recent history of colds or allergies. A visual examination of the outer ear and ear canal often reveals enough information to make a diagnosis, although other tests may be performed to confirm an ear infection.

In many cases, ear infections clear on their own over a period of time without the need for prescription medications. These cases often resolve in as little as 24 to 48 hours. Less often, antibiotics are required to treat a bacterial infection. When infections continue to recur, ear tubes may be surgically placed inside the ears. This involves creating a tiny opening in the eardrum and inserting tubes that allow air to get into the middle ear and let fluids drain out.

Ear infections are conditions that involve infection and often inflammation of different areas of the ear. They most often result from viral, fungal or bacterial infection. In most cases, ear infections are not serious and clear on their own. However, bacterial infections may require treatment with antibiotics. Left untreated, these infections may lead to serious complications, particularly for young children.

Ear infections can occur in the outer, middle and inner ear. The outer ear is the visible part of the ear. It includes the entire exterior ear (auricle), which is made up of cartilage and skin, and the earlobe. The outer ear also includes the ear canal (passageway that carries sound from outside the body to the eardrum). The eardrum (tympanic membrane) is a thin membrane located at the innermost end of the ear canal that separates the outer and middle ear.

The middle ear is the small, pea-sized chamber located just behind the eardrum. It is normally filled with air that enters the area via the eustachian tubes (canals that go from the back of the nose and throat to the middle ear). The eustachian tubes (sometimes called auditory tubes) prevent pressure from building up in the ears. They generally remain closed, but open during swallowing or yawning to balance the air pressure in the middle ear with the air pressure outside the ear. The middle ear also contains tiny bones that send vibrations from the eardrum to the inner ear.

The inner ear consists of the cochlea (structure that contains the organ necessary for hearing) and the labyrinth (interconnecting cavities that help maintain balance). Nerve endings in the inner ear convert sound vibrations into signals to the brain that allow hearing to occur.

Most ear infections occur in the outer or middle ear – inner ear infections are rare. Ear infections are not contagious. However, the viral infections (e.g., colds, the flu) that may precede them are contagious and can lead to ear infections. Ear infections are much more common in children than adults because their eustachian tubes are shorter and narrower, making them more difficult to drain. In addition, the adenoid tissue in the back of the throat is larger and may block the eustachian tubes.

Left untreated, ear infections sometimes can cause more serious complications. These may include:

• Ruptured eardrum. Can ccur when the eardrum perforates due to the pressure of fluid within middle ear. After rupture, fluid drains out of the ear canal, relieving pressure and pain in the middle ear. Surgery may be necessary to repair the perforation, although ruptures usually heal on their own. Ruptures occur infrequently and hearing is not usually impaired.
  
  
• Additional ear infections. Untreated middle ear infections can rupture an eardrum, resulting in the leakage of pus into the ear canal and causing an infection of the outer ear. In addition, untreated outer ear infections can result in recurring infections.
  
  
• Cellulitis. An infection of the skin surrounding the external ear. Outer ear infections that are untreated or do not respond to treatment may recur and lead to cellulitis.
  
  
• Cholesteatoma. Buildup of cellular debris in the middle ear. This is usually the result of chronic ear infections. It may cause damage to structures within the middle ear.
  
  
• Structural damage inside the ear. The small bones of the middle ear and other structures in the ear may become damaged if a middle ear infection is left untreated and fails to spontaneously resolve.
  
  
• Permanent hearing loss. This can occur once there is structural damage to the middle ear. It can also occur with inner ear infections. Children who experience hearing loss, even temporary hearing loss, at a young age may have difficulties in language acquisition and speech development.
  
  
• Acute mastoiditis. Occurs when ear infection spreads to the mastoid bone behind the ears. This complication is uncommon and is usually the result of a middle ear infection.
  
  
• Meningitis. Infection that causes inflammation of the membranes covering the brain and spinal cord. This may occur as a result of an ear infection and is a serious and potentially deadly disorder.

There are several different types of ear infections. These include:

• Otitis media. Results from inflammation and fluid buildup in the middle ear. If enough bacteria grow in the area, the fluid may become infected. Otitis media is the most common type of ear infection in young children, occurring most often between the ages of 6 months and 24 months. About 75 percent of children develop otitis media by the time they are 3 years old, and half of these children have three or more ear infections during this time, according to the National Institutes of Health. This makes otitis media the most common illness in babies and young children.
  
  Otitis media occurs when viruses, fungi or bacteria cause the eustachian tubes to swell and become blocked. Without air traveling to or from the middle ear, pressure inside the ear increases. This can be extremely uncomfortable and may feel as if the ear is a blown-up balloon, ready to pop. Middle ear infections also cause fluid accumulation and pus production within the middle ear. This may restrict the ability of sound vibrations to travel from the eardrum to the inner ear, causing temporary hearing loss.
  
  In addition, the eardrum may turn pink or red, and fluid buildup and pus produced in the middle ear may press against the eardrum, causing it to stretch tightly or to bulge. However, fluid buildup in the middle ear may also occur without an infection, often as the result of excess fluid produced during a previous episode of a cold or the flu. This form is called otitis media with effusionotitis media with effusion. Otitis media with effusion sometimes precedes an episode of otitis media and almost always follows it (e.g., fluid remains in the ear even after an infection clears). All middle ear infections may be acute (a single, short episode) or chronic (in which infections recur).
  
  
• Otitis externa. Also called swimmer’s ear or external otitis, it is an inflammation, irritation or infection of the ear canal (passageway that carries sound from outside the body to the eardrum) and/or outer ear (the visible part of the ear, including the earlobe). Despite its nickname, it can occur without swimming. Anything that causes microorganisms to enter a break in the lining of the ear canal or anywhere on the outer ear can cause swimmer’s ear.
  
  Infection occurs in the outer ear when the ear canal is exposed to excess moisture that causes an overgrowth of the bacteria and fungi that normally exist within the ear canal. Skin can become soggy, diluting the acidity normally present in the lining of the ear canal that helps prevent infection. This can lead to inflammation of the ear canal that may extend to the outer ear, causing pain. Fluid may also become trapped in the ear canal due to a buildup of ear wax.
  
  Other factors that may cause this condition include scratches or abrasions from objects (including hearing aids and ear plugs) placed into the ear canal or from physical injury to the outer ear. It can also occur from exposure to irritating chemicals (e.g., hairspray, hair dye) or contaminated water.  The excessive removal of ear wax from the ear canal can also lead to otitis externa. Outer ear infections are common in both children and adults.
  
  
• Labyrinthitis. Infection of the inner ear that affects balance and hearing. It is rare and may occur in two different forms:
  
  
• Viral labyrinthitis. Inner ear infection caused by viruses (e.g., viruses that cause the measles, mumps or flu). Viral labyrinthitis usually resolves on its own, without treatment, and leaves no long-term complications.
  
  
• Bacterial labyrinthitis. Inner ear infection caused by bacteria, such as when a middle ear infection (otitis media) spreads to the inner ear, or as the result of the spread of meningitis (inflammation of the protective cover of the brain and spinal cord). Significant permanent hearing loss is a common result of bacterial labyrinthitis, as well as damage to the structures within the inner ear. It is very rare due to the use of antibiotics to treat middle ear infections. However, it may still occur as a complication of bacterial meningitis.

Ear infections most often occur as a result of a viral, fungal or bacterial infection. Most cases of ear infections among children occur after a cold or the flu, and affect the middle ear (otitis media). Infection can also occur as a result of exposure to excess moisture or injury to the outer ear or ear canal (swimmer’s ear). Other factors that may increase the risk of ear infections include:

• Exposure to people with a contagious illness (e.g., cold, the flu)
  
  
• Not being breastfed
  
  
• Exposure to children in day care settings
  
  
• Ear piercings
  
  
• Excess ear wax
  
  
• Foreign objects in the ear canal
  
  
• Injuries to the outer ear
  
  
• Use of irritating chemicals (e.g., hair spray, hair dye) near the ear
  
  
• Lying down while drinking from a baby bottle
  
  
• Use of a pacifier

Young children are more susceptible to ear infections than any age group. Most children in the United States experience one or more ear infections by the time they enter school, with otitis media being diagnosed most often. Many children experience recurring ear infections.

Children are especially vulnerable to ear infections because their immune systems are not fully developed until about age 7. In addition, children have different size structures within the ear, nose and throat that are more likely to lead to pressure and fluid buildup in the middle ear. For example, their eustachian tubes are small and narrow, and are more easily clogged. These tubes are horizontal in young children, so viruses or bacteria can be easily transferred from the nose to the middle ear. The adenoid at the back of upper throat (near the eustachian tubes) is large in children, which can interfere with opening of the tubes and contribute to pressure buildup in the middle ear.

Signs and symptoms of ear infections may differ, depending on the location and cause of the problem. Often, symptoms of ear infections are preceded by symptoms of a cold or the flu, especially in young children. Parents are urged to be especially alert for signs or symptoms of ear infection after their child has these illnesses.

Symptoms often associated with ear infections include:

• Earache
• Itching or other discomfort in the ear or ear canal
• Red, swollen skin of the outer ear or ear canal
• Drainage from the ear
• Hearing loss (usually temporary)
• Ear noise or buzzing
• Fever
• Chills
• Irritability
• Decreased appetite
• Dizziness
• Nausea and vomiting
• Diarrhea

Young children whose hearing is affected by recurring ear infections may experience impaired or delayed speech development. For this reason, it is important to treat ear infections promptly to ensure that fluid in the ear clears and hearing returns to normal. Inner ear infections (labyrinthitis) may affect balance and result in a spinning sensation (vertigo).

In diagnosing an ear infection, a physician will perform a complete physical examination and compile a thorough medical history. Special attention will be paid to the throat, sinuses, head, neck and lungs. The physician likely will ask about any recent history of colds or allergies.

In the case of swimmer’s ear, infection may be obvious from such symptoms as redness and tenderness of the outer ear or ear canal. The skin may resemble eczema, with a scaly, shedding look.

In diagnosing otitis media, the physician may use a special lighted instrument (otoscope) to look at the ear canal and eardrum for signs of redness or swelling. In some cases, holes in the eardrum (perforations) may be evident.

A bulb may be attached to the otoscope that can push air into the ear canal to test the mobility of the eardrum. A middle ear infection – in which fluid or pressure in the middle ear presses against the eardrum – can restrict movement of the eardrum.

Patients who experience recurring ear infections may undergo testing of their hearing to make sure the infections have not caused permanent damage.

In many cases, ear infections clear on their own over a period of time, often within 24 to 48 hours, without the need for prescription medications. Patients often are encouraged to simply monitor their infection and to watch for and note any worsening of their condition – an approach known as “watchful waiting.”

While waiting for the body to heal, patients can take several steps to relieve discomfort. These may include applying a warm cloth or warm water bottle to the ear and using over-the-counter (OTC) medications to relieve symptoms of discomfort.

In some cases, prescription medications may be necessary to treat a patient’s ear infection. Antibiotics (pills or ear drops) are used to fight infections that are bacterial in nature, while corticosteroids can help reduce itching and inflammation. Sometimes, when the ear canal is inflamed or swollen, a cotton wick is placed in the ear to allow ear drops to travel to the end of the canal. Increasingly, bacteria are becoming resistant to many common antibiotics. This means that a patient may have to try more than one type of antibiotic before finding one that is effective. Patients with allergies may also be given medications to ease or prevent allergy symptoms in some cases. This may help prevent or reduce the swelling of the eustachian tubes, allowing fluid to drain from the middle ear.

Patients often are urged to keep the ears clean and dry during treatment. This may include preventing water from entering the ears during showering, shampooing and bathing. Patients may also want to avoid any situation that puts added pressure on the ear, which can increase pain associated with ear infections. Situations to be avoided include air travel and scuba diving.

People can take various steps to help prevent ear infections from occurring. Washing hands frequently prevents the spread of germs that cause respiratory infections that often lead to ear infections. Avoiding people who are sick with a cold or the flu can also help prevent respiratory infections that can lead to ear infections. Effective treatment of allergies and asthma also can reduce the risk of developing an ear infection. Avoiding exposure to second-hand tobacco smoke may reduce the occurrence of ear infections in young children.

Children are most at risk for developing middle ear infections. Innoculating children with pneumococcal vaccine helps prevent infections from the organism most often associated with middle ear infections. Children with a history of recurrent ear infections sometimes are given low doses of antibiotics for a few weeks as a preventative measure.

Other steps that can be taken to help prevent ear infections include:

• Do not insert anything into the ear canal. Anything, including fingers and cotton swabs inserted into the ear may injure the tissue lining the canal and cause an ear infection.
  
  
• Take proper precautions before and after swimming. Some people may be urged to use earplugs when swimming or bathing to keep the ear canal dry. Drying the ears with a towel or hair dryer (on low setting) after swimming also can lower the risk of ear infections. Physicians sometimes recommend the use of special ear drops following swimming.
  
  
• Breastfeed babies. Breastmilk provides antibodies that help make children less prone to infections, including ear infections.
  
  
• Monitor pacifier use in infants. Infants (especially those between the ages of 6 and 12 months) who use pacifiers have a higher risk of developing ear infections. However, in younger infants, pacifier use may help reduce the risk of sudden infant death syndrome (SIDS). Thumb sucking does not appear to increase the risk of ear infection.
  
  
• During bottlefeeding, hold children in an upright, seated position. Lying down while drinking promotes infection because liquid may travel up the eustachian tubes, increasing the risk of infection.

Preparing questions in advance can help patients have more meaningful discussions with healthcare professionals regarding their conditions. Patients may wish to ask their doctor the following questions related to ear infections:

1. How can I tell if I have an ear infection?
   
   
2. At what point should I come in to see you when I think I have contracted an ear infection?
   
   
3. I think my child may have stuck something in his/her ear. Can this cause an ear infection?
   
   
4. What are the benefits and risks of using antibiotics to treat an ear infection?
   
   
5. Should I use over-the-counter pain relievers to relieve the pain of an ear infection?
   
   
6. Are there any other medications (prescription or over-the-counter) you recommend for treating an ear infection? What are their side effects? What medications I should avoid?
   
   
7. How long will the fluid remain in my ear after a middle ear infection? How can I tell when it is gone?
   
   
8. What changes in my condition should I report to you?
   
   
9. Is my child a candidate for ear drainage tubes?
   
   
10. After my ear infection has cleared, should my hearing be tested?
    
    
11. Is there anything I can do to prevent myself from getting an ear infection?
    
    
12. Should I wear earplugs while swimming? Will this prevent swimmer’s ear?
    
    
13. Are there any immunizations my child can receive that might help prevent ear infections?
    
    
14. Is it safe to pierce my ears? What can I do to minimize the risk of infection after the ears are pierced?