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Why We Get Ear Infections

Ear Infections

Sometimes it seems like kids are always getting ear infections. Ear infections are very common in children. Children get ear infections about two out of every three times they have a cold. Children are more prone to ear infections because their small ears do not drain fluid as well as adult ears. Kids’ immune systems are also immature, and this increases the likelihood of certain infections.

There are three types of ear infections. Each type is defined according to where they occur in the ear canal. An ear infection may take place in the inner, middle, or outer ear. Each type of ear infection may exhibit different symptoms.

Two girls swimming together, possible cause of swimmer's ear.

Swimmer’s Ear (Outer Ear Infection)

An infection of the ear canal (the outer ear) is sometimes referred to as swimmer’s ear. The name comes from the fact that it most often occurs when the ear canal stays wet long enough for bacteria or other organisms to grow.

Causes of Swimmer’s Ear

The skin lining the ear canal and outer ear offers protection against infections from bacteria and fungi. However, when this skin barrier is broken, bacteria or fungi can invade the ear and cause infection. This ear infection is known as swimmer’s ear or an outer ear infection. Swimmer’s ear can be caused by too much moisture in the ear canal or from inserting something too deep into the ear.

Swimming or showering causes the acidic environment of the ear canal to be altered, which allows bacteria or fungi to invade the ear. The lining of the ear canal can also be broken by scratching or injuring from cotton swabs or other objects when inserted into the ear. Other causes of swimmer’s ear include chemicals that irritate the ear canal and skin conditions that cause the skin to crack.

Swimmer’s Ear Symptoms

Swimmer’s ear is typically painful. Pain caused by swimmer’s ear gradually begins over a day or two. The pain is especially intense when the ear is touched or pulled, or when chewing. Symptoms of swimmer’s ear include the following:

  • Ear pain or earache (almost always involves only one ear)
  • Ear canal itching
  • Outer ear redness
  • Ear canal swollen shut
  • Ear draining fluid or pus (drainage may be clear, white, yellow, or sometimes bloody and foul smelling)
  • Fluid crusting at the opening of the ear canal
  • Trouble hearing
  • Ringing in the ear (tinnitus) and dizziness or spinning sensation (vertigo)
  • Feeling of fullness in the ear
  • Pain on the side of the face or neck
  • Swollen lymph nodes

Swimmer’s Ear Treatment: Drops and Home Remedy Options

Treatment for swimmer’s ear includes avoiding swimming, over-the-counter pain relievers, and possibly antibiotics. Doctors may prescribe medications that offer symptom relief and clean the affected ear. Home remedies for swimmer’s ear include applying heat to the ear with a heating pad and a white vinegar rinse to help restore the ear canal’s natural pH and reduce swelling.

Picture of a healthy eardrum.

Ear Infection Diagnosis

The diagnosis of an ear infection is made by examining the inside of the ear with an instrument called an otoscope. A normal, healthy eardrum has a pinkish-gray color as shown here. The healthy eardrum is clear, while an infected eardrum is bulging (swollen) and reddened. A doctor may also perform a tympanometry, which measures how the eardrum responds to a change of air pressure inside the ear. Hearing tests are also common ways to diagnose an ear infection, especially in children who have fluid in both ears. Blood tests can also be taken if there are signs of immune problems.

Diagram of the inside of an ear (eardrum, Eustachian tube, and middle ear).

Middle Ear Infection

Middle ear infections are caused by bacteria and viruses. Swelling from an upper respiratory infection or allergy can block the Eustachian tubes, which would prevent air from reaching the middle ear. A vacuum and suction then pulls fluid and germs from the nose and throat into the middle ear. Since the tubes are swollen, the fluid cannot drain. This provides a medium for the growth of bacteria or virus, which leads to a middle ear infection.

The otoscope can blow a tiny puff of air against the eardrum to see if it vibrates normally. When there is fluid present in the middle ear, the eardrum does not vibrate normally.

Eustachian Tube

The Eustachian tube is the canal that connects your middle ear to your throat. When the Eustachian tube is open as it is normally, it prevents fluid and air pressure from building up inside the ear. Infections like colds, the flu, or allergic reactions can cause the Eustachian tube to become swollen and blocked.

Middle Ear Infection Symptoms

Symptoms of a middle ear infections tend to occur 2 to 7 days after the start of a cold or other respiratory infection. Middle ear infection symptoms may include:

  • Ear pain (mild to severe)
  • Fever
  • Drainage from the ear that is thick and yellow or bloody
  • Loss of appetite, vomiting, and grumpy behavior
  • Trouble sleeping

Middle Ear Infection Treatment

Treatment for middle ear infections typically focuses on relieving pain. Over-the-counter pain and fever medications such as acetaminophen and ibuprofen are used. Of note, you should never give aspirin to children. A doctor may prescribe antibiotics for a middle ear infection, but ear infections tend to get better without them. If children have repeat ear infections, a doctor may prescribe long-term oral antibiotic treatment. Inserting ear tubes or removing the adenoids or tonsils may also be a solution for children who have repeat middle ear infections.

P middle ear infection with fluid buildup.

Inner Ear Infection (Labyrinthitis)

Labyrinthitis is inflammation inside the inner ear. Labyrinthitis occurs when the labyrinth, a part of the inner ear that helps control your balance, gets swollen. The inflammation of the labyrinth can be caused by respiratory illnesses, viral and bacterial ear infections.

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