What is an Ear Infection?
An ear infection is an inflammatory condition of the ear. Usually affecting the middle ear (otitis media), infections can also occur in the outer ear (otitis externa) and inner ear (labyrinthitis).
A middle ear infection, caused by bacteria or a virus, is prevalent in childhood. About 30 percent of children below three years old will see a doctor for this condition. (1)
An outer ear infection is sometimes called swimmers ear. It is most often caused by bacteria or fungi building up within moisture in the ear canal. (2)
An inner ear infection impacts on the labyrinth, the innermost part of the ear, usually due to bacterial or viral infection. (3)
The ear is made up of three distinct parts: the outer, middle and inner region.
The outer ear is the part you can see and includes the opening to the ear and the ear canal. At the end of this canal is the eardrum (tympanic membrane) which separates the middle ear from the ear canal.
Behind the eardrum is an air filled space, the middle ear, containing three small bones (ossicles). The eardrum vibrates when sound waves hit it and transfers these vibrations to the ossicles. These in turn pass sound waves to the inner ear.
The inner ear (labyrinth) houses a small, curled tube filled with fluid and lined with tiny hair cells called the cochlea. It also contains fluid filled canals (vestibular canals) responsible for sense of balance.
When sound passes to the cochlea it is converted to nerve impulses which are fed to the brain. The sound is then interpreted and the brain tells us what we are hearing, whether it is speech, music, traffic noises etc. (4, 5)
Ear infection, as we have mentioned, can affect all three areas of the hearing organ, however, the most common is middle ear infection. The middle ear is connected to the throat by a small canal called the eustachian tube. This tube helps balance pressure between the outer and the inner ear.
If fluid builds up behind the eardrum and the eustachian tubes are partially or fully blocked, it cannot drain away. Consequently, the middle ear becomes a breeding ground for bacteria and viruses, causing infection. (6)
The symptoms associated with an ear infection include:
Pain or a feeling of discomfort emanating from inside the ear is a common symptom of this condition.
When viruses or bacteria, as a result of a cold or flu for example, enter the throat they cause inflammation. This can spread to the eustachian tube and middle ear resulting in swelling and narrowing of these drainage tubes.
A build up fluid ensues and presses against the eardrum, resulting in pain.
Another factor which affects the eustachian tubes is enlarged adenoids. These are situated near the opening of the tubes, when they become inflamed or enlarged they can block them. Sinusitis and allergies can also hinder drainage from the eustachian tubes.
In young children the eustachian tubes are narrow and not fully formed, which makes them more susceptible to middle ear infection.
An outer ear infection causes pain in the earlobe itself, or in the canal at the entrance to the ear. The ear might appear red or inflamed. This infection is most often caused by water or moisture in the ear, wearing headphones or a hearing aid.
When a child has pain, they may be too young to vocalise this. Signs to look for are pulling or tugging at the ear, being fussier than usual and not sleeping well. They might also shake their head. (7, 8)
Drainage From the Ear
There are occasions when a fluid build up in the middle ear is so great it can perforate the eardrum. When this happens sticky, thick fluid which may contain pus and blood leaks from the ear (otorrhea).
Perforation of the eardrum can result in relief of pain felt with a middle ear infection.
However, the hole created is usually very small and will generally heal of its own accord. (9)
Discharge from the ear can also indicate an outer ear infection. (10)
Fluid build up in the middle ear can interfere with the ability to hear clearly. Sounds might be muffled and your ears feel like they are “full”. (11)
An affected sense of balance is most often associated with an inner ear infection. A feeling that either you or your surroundings are spinning and moving is common (vertigo). It feels a bit like being on a fairground ride which spins you round and round. (11)
There are no stages of ear infections. There are however three main types of ear infection relating to the middle ear.
Acute Otitis Media
This ear infection is the most common and involves infection in parts of the middle ear. It becomes swollen and fluid is retained behind the eardrum. Pain will be felt in the ear (earache) and it might be accompanied by a fever. (16)
Otitis Media with Effusion (OME)
Sometimes called glue ear, this occurs when fluid is retained behind the eardrum after an infection has cleared. Children who suffer from glue ear might feel pressure inside the ear and find their hearing is impaired. There is often no pain associated with this condition, however it can result in hearing loss.
There are occasions when there will be no symptoms, however, the fluid build up can be seen by a doctor when examined. (17)
Chronic Otitis Media with Effusion (COME)
This condition involves retention of fluid behind the eardrum. This remains in the middle ear for a long time or is recurrent. Again, there will be no infection and sometimes no symptoms, other than potential hearing impairment.
This can also make it more difficult, especially for children, to fight new infections in the ear. (18)
Often an ear infection will resolve itself within a few days. Over the counter medications can also help relieve any associated pain.
If the infection does not clear within a few days a doctor may prescribe antibiotics. This is also likely if fluid leaking from the ear is apparent.
Decongestant nasal sprays or drops can help open the eustachian tubes and relieve swelling. They should however only be used for a few days. (19)
In cases of otitis media with effusion, whether acute or chronic, a small tube may be surgically placed in the ear. This will enable airflow and prevent fluid buildup. (20)
Outer ear infections might be treated with antibiotic ear drops if there is a bacterial infection. Antifungal ear drops will be prescribed if the cause is a fungal infection. In either case steroidal ear drops can reduce swelling.
If the infection in the outer ear is severe and bacterial in nature, oral antibiotics might be prescribed. (21)
Inner ear infections will generally clear of their own accord in a few weeks. Staying hydrated, bed rest and pain medication may ease the symptoms.
The causes of these infections tend to be viral, however if bacterial presence is suspected antibiotics might be prescribed.
Severe incidences might need referral to a ear, nose and throat specialist. When symptoms persist for months or even years, there is a specialist physiotherapy (vestibular rehabilitation therapy) which might help relieve symptoms. (22)
What is an ear infection? An ear infection is an inflammatory condition of the ear. Usually affecting the middle ear (otitis media), infections can also occur in the outer ear (otitis externa) and inner ear (labyrinthitis).
What are the signs of an ear infection? Pain will be felt in the ear and can be accompanied by impaired hearing, fever, fluid drainage, balance issues and nausea.
How do you develop an ear infection? Ear infections are usually caused by viral, bacterial or fungal infections.
How are you diagnosed for an ear infection? A physical examination by a medical professional will usually detect an ear infection. A specialized instrument (otoscope) is used to look into the ear canal. Hearing can be checked with another instrument called a tympanometer, which is also able to check movement of the eardrum. (23)
What is the best treatment for an ear infection? Often an ear infection will clear of its own accord. However, if it persists, your doctor will discuss the best treatment options with you.
What are the long term complications of an ear infection? The long term prognosis of most ear infections is good, yet when the inner ear is involved hearing loss is a possibility. (24)
Is an ear infection considered a disability? An ear infection in itself is not a disability, although resulting hearing impairment can be considered a disability in some instances. (25)
Is there a cure for an ear infection? Most ear infections will clear on their own or respond well to treatment.
Is an ear infection life threatening? An ear infection is not life threatening. That said, if a middle ear infection is not treated it can lead to mastoiditis, an infection of the mastoid bone. This bone is situated behind the ear and infection can lead to life-threatening health conditions like a blood clot, brain abscess or meningitis. (26)
An ear infection can be viral, bacterial or fungal and affect any part of the ear. While more prevalent in young children, it can affect people at any age.
Most instances of an ear infection will clear on their own accord in a few days. If medical intervention is required, diagnosis is usually straightforward. With treatment the prognosis is generally positive with no lasting outcome.