While ear infections are typically found in children, adults can also get them. Keep in mind that much of our understanding of ear infections comes from research done on children, which has been extrapolated and applied to adults.
The middle ear, which sits behind the eardrum, is contiguous with the outside world — not through the ear but through the eustachian tube that leads into the nasopharynx (where the nasal canal meets the throat). An infection occurs when this eustachian tube becomes infected and obstructed. This walls off the middle ear from the nasopharynx, leading to an infection.
Ear Infection Symptoms
Ear infections tend to be associated with the following symptoms:
- Ear fullness: The sensation of clogged ears causes the urge to yawn or swallow repeatedly, which provides little to no relief. Hearing is slightly diminished or muffled.
- Earache: This is what most people are used to feeling when they develop ear infections. Whatever provokes the pain is often what doctors use to distinguish between the three most common causes of earaches. See the diagnosis section below.
- Decreased or muffled hearing
- Hearing loss: This is caused by a buildup of fluid within the middle ear chamber.
- Fevers: High fevers above 102 degrees Fahrenheit with earaches are unusual, but could signal a complicated infection that should be seen by the doctor right away.
If you experience a sudden and unexplained relief from your earache, or notice mucus drainage, you likely just ruptured your eardrum.
When Should I See a Doctor for an Ear Infection?
Antibiotics are required for ear infection treatment, and pain medication such as naproxen or ketorolac can be helpful. To reduce the risk of serious complications associated with untreated ear infections, we recommend antibiotics for all patients. A typical antibiotic is an augmentin, which is a penicillin that most effectively treats bacterial organisms that cause ear infections. Patients with penicillin allergies, histories of multidrug-resistant infections, or recent unsuccessful penicillin treatment will discuss the following treatment options with their doctor:
- Penicillin allergy: Cefdinir or Cefpodoxime can be prescribed for mild Penicillin allergies. Doxycycline or Azithromycin (often referred to as a z-pack) can be prescribed for severe penicillin allergies.
- Penicillin resistance or recently failed treatment: Cefdinir or Cefpodoxime may be tried first. If we cannot use those, Levofloxacin or Moxifloxacin can be the best course of treatment.
Please talk to your doctor about these options, and don’t ever take medications lying around the house. Dosing and frequency often change depending on the infection and, if taken incorrectly, can lead to harmful side effects or ineffective treatment.
Other Causes of Ear Pain and Ear Fullness
There are two main types of ear infections: a middle ear infection and swimmer’s ear. Sometimes these can be mistaken for one another especially when the eardrum (tympanic membrane) is perforated or ruptured. The most obvious way to distinguish between the two is reproducible pain. The pain from swimmer’s ear is reproducible when you pull on your ear whereas with a middle ear infection you might feel some discomfort but it won’t be a full reproduction of the pain. Swimmer’s ear almost never accompanies sinus congestion, sore throat, fevers, etc. If you are experiencing any of those other symptoms, then you are likely dealing with a middle ear infection.
It’s important to note, the tympanic membrane separates the outer ear (the part infected by swimmer’s ear) and the middle ear (the part infected with a middle ear infection). In either infection, the tympanic membrane itself can become infected and rupture. Allowing the infection to cross over and producing symptoms from both middle ear infection and swimmer’s ear. Tympanic membrane rupture usually is accompanied by sudden relief of ear fullness as the pressure build-up is relieved and can occasionally cause a mucous discharge from the ear.
Other infections can take hold deeper in the neck or head, causing ear pain. This pain is not an actual infection of the ear itself. Rather, it’s typically related to a compromised immune system or recent head or neck surgery.
Middle ear infections are a common condition that most people experience at least once in their life. Symptoms typically include earache, ear pain, ear fullness, change in hearing or hearing loss, and sometimes fevers and chills. It’s important to distinguish middle ear infections from the other common cause of ear aches, swimmer’s ear. The treatment is very different depending on the type of infection you have. While both infections require prescription antibiotics, swimmer’s ear antibiotics are administered through ear drops whereas middle ear infections are administered as oral medications.