Ear infection

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Ear infections most often affect young children, but older children and adults can get them too. Atrium Health Floyd and Harbin Clinic pediatricians and primary care providers offer reliable care for routine ear infections. Our ear, nose and throat (ENT) doctors provide specialized treatment for more complex infections.

What is an ear infection?

Middle ear infections

The most common type of ear infection, otitis media, occurs when fluid builds up in your middle ear, causing inflammation. Your middle ear sits behind your eardrum and contains three tiny bones that transmit sound to your inner ear.

Eustachian tubes drain fluid from your middle ear to the back of your throat. If one of these tubes becomes blocked, fluid has no way to escape and collects there.

Ear infections can affect people of any age, but they are most common in young children. As many as 90% of children will develop an ear infection before they begin school. This frequency is because children’s eustachian tubes are smaller and more horizontal, so they don’t drain as well. Children also have a developing immune system that isn’t as effective at fighting infections.

Outer ear infections

Otitis externa (swimmer’s ear) is an ear infection in the outer ear, between the ear opening and eardrum.

Causes of ear infections

What causes middle ear infections?

Middle ear infections are caused by bacteria and viruses. They usually happen after an upper respiratory infection, such as a cold, flu or sinus infection. Microorganisms from these infections spread to the eustachian tube and middle ear.

The eustachian tubes can also become blocked for other reasons, such as:

Allergies
Drinking while lying down
Enlarged adenoids (lymph tissue in the upper throat)
Mucus and saliva produced during teething
Tobacco smoke

What causes outer ear infections?

Outer ear infections are caused by bacteria and, less often, fungi. Swimming in unclean water can lead to swimmer’s ear. Outer ear infections can also happen if you:

Damage the skin in your ear canal
Have a chronic skin condition that affects your ear canal

Types of middle ear infections

Doctors classify middle ear infections as:

Acute: An ear infection that starts over a short period
Chronic: An ear infection that lasts a long time or returns repeatedly

In some cases, fluid can build up behind the eardrum, but there’s no bacterial infection. This condition is called otitis media with effusion.

Ear infection symptoms

Middle ear infection symptoms

Typical symptoms of an acute middle ear infection include:

Ear pain
Fever
Muffled hearing

Young children may be fussy, tug at their ear, eat less or have trouble sleeping. Other symptoms include drainage from the ear, which indicates a ruptured eardrum and hearing problems. Chronic middle ear infections can cause lasting hearing loss as well as speech and language delays in children.

Outer ear infection symptoms

Symptoms of swimmer’s ear include:

Drainage from the ear that may be yellow, pus-like or foul-smelling
Ear pain
Hearing loss
Itching

Ear infection diagnosis

Diagnosis is typically based on symptoms, medical history and a physical exam. Doctors use an instrument called an otoscope to look inside the ear for signs of infection.

For severe, chronic or recurrent infections, your doctor may perform other tests, such as:

CT imaging to check if the infection has spread beyond the middle ear
Cultures of the ear fluid to detect bacteria
Hearing tests to assess for hearing loss
Tympanometry to check the flexibility of your eardrum

Ear infection risk factors

Middle ear infection risk factors

Personal and environmental factors can increase the risk of ear infections. Some of these factors include:

Recent upper respiratory tract infection
Allergies
Attending day care
Changes in altitude
Enlarged adenoids
Exposure to smoke
Family history of ear infections
Male sex
Previous ear infection
Weakened immune system

Outer ear infection risk factors

Factors that increase your chance of otitis externa include:

Age between 5 and 9
Narrow ear canals
Putting foreign objects in your ears (cotton swabs, fingers, hearing aids, earplugs)
Swimming, especially in water contaminated with bacteria
Skin diseases, such as eczema, psoriasis or acne
Warm, humid temperatures
Weakened immune system

Ear infection prevention

Middle ear infection prevention

The following measures can help reduce the risk of ear infections:

Avoid exposure to cigarette smoke
Boost your baby’s immunity by breastfeeding for at least the first 12 months
Do not put your child to bed with a bottle
Wash hands and toys often
Limit exposure to other people who are sick
Stay up to date with vaccinations

Outer ear infection prevention

Steps you can take to prevent an outer ear infection include:

Don’t poke, scratch or insert anything into your ear canal
Dry your ears well after showering and swimming
Remove and clean hearing aids each night
Wear a swim cap or ear plugs when swimming

Ear infection treatment

Middle ear infection treatment

Most ear infections are minor and get better on their own or with antibiotics. Your doctor will determine the right treatment approach. They may suggest waiting a day or two before taking an antibiotic.

To reduce pain, over-the-counter ear drops or pain relievers such as ibuprofen or acetaminophen can help (do not give children aspirin). Getting plenty of rest and fluids will also speed healing.

For chronic ear infections, an ear, nose and throat (ENT) specialist may assist with care. They offer advanced treatments, including surgery to: