Ear Infections: Types, Causes And Symptoms – Forbes Health - Forbes

Though ear infection is a common term, there are several types of ear infections, each of which have different causes and symptoms.

An outer ear infection (otitis externa) happens when the natural skin flora is disrupted or invades into an otherwise sterile environment in your ears, says Ana Kim, M.D., an otolaryngologist and associate professor of otolaryngology, head and neck surgery at Columbia University Irving Medical Center in New York City. Ear infections can be bacterial, fungal or viral and can affect one or both ears.

A middle ear infection (otitis media) may occur when fluid isn't draining properly from behind the eardrum, located in the middle ear, which commonly happens during an upper respiratory infection, says Dr. Goudy. Swelling and congestion at the back of the nose can lead to a blockage of the eustachian tube, which drains fluid from behind the ear drum into the back of the nose. A middle ear infection can also be caused by bacterial or viral overgrowth behind the eardrum.

"If the eustachian tube can't open and drain effectively (this is why your ears feel stopped up or pressurized during a cold), then the fluid just sits behind the eardrum and can get infected by both bacteria and viruses," explains Dr. Goudy.

The blockage of the ears and eustachian tube are what leads to middle ear infections in both adults and children, but since children tend to contract more colds—between eight and 10 colds before the age of two, according to Pediatrics and Child Health—they're more likely to get ear infections. "The eustachian tube in adults is bigger and more vertically oriented (than in children), which also makes it easier for their ears to drain," says Dr. Gouldy.

Recurrent middle ear infections are defined as three or more ear infections in a six-month period or four or more infections in a year, adds Dr. Goudy.

Types of Ear Infections

Symptoms of ear infections can differ depending on which ear compartment is infected, says Dr. Kim. How long an ear infection lasts depends on several factors, including the cause of the infection, whether the person has underlying medical conditions and the severity of the infection, she says.

Mild symptoms of an outer or middle ear infection might go away without treatment in one to two weeks, especially if the infection is viral, says Karen Hoffmann, M.D., a board-certified otolaryngologist at Piedmont Ear, Nose, Throat and Related Allergy in Atlanta.

"Inner ear infections can last longer, and patients may have some persistent disequilibrium and imbalance even after the acute infection resolves," says Dr. Hoffmann.

Outer Ear Infection

Symptoms of an outer ear infection (otitis externa) include pain, drainage and diminished hearing, according to Dr. Kim.

The outer ear consists of the auricle and external auditory canal, she adds. Its surface is lined by skin acting as a barrier to protect against invasion by unwanted microorganisms. When the skin barrier is compromised, it can turn into an outer ear infection, known as otitis externa.

Outer ear infections are a fairly common condition and are seen most often after frequent water exposure, such as swimmers' ear, says Dr. Hoffmann. They can also be caused by overuse of cotton swabs in the ear canal.

"Typically, patients will have pain, swelling of the ear canal skin, drainage from the ear and hearing loss," Dr. Hoffmann says.

Depending on which part of the outer ear anatomy is involved and the ear infection's cause, diagnosis and treatment varies, says Dr. Kim.

"Ear infections affect people of all ages," she adds. "Folks who cause damage to the delicate outer ear skin by use of mechanical trauma via pins, Q-tips or fingers are prone to developing outer ear infections. Those with skin conditions, such as eczema, psoriasis or dermatitis have compromised outer skin and are thus more prone to an outer ear infection."

Middle Ear Infection

Middle ear infections often include symptoms like ear fullness, pain, diminished hearing, dizziness and, more rarely, facial paralysis. Very young children might be fussy or cry, have trouble sleeping or hearing or might have a fever.

The middle ear is composed of the eardrum, also referred to as the tympanic membrane. The middle ear space behind the eardrum houses the hearing bones, or ossicles, which include three tiny bones called the malleus, incus and stapes, says Dr. Kim.

Commonly called an earache, a middle ear infection, or otitis media, involves the air-containing space behind the eardrum and around the hearing bones. Infections in this part of the ears are common, particularly in children, notes Dr. Hoffman.

Middle ear infections often occur after an upper respiratory infection, such as the common cold, flu, acute sinusitis or COVID-19, adds Dr. Hoffmann.

"The middle ear is a sterile environment, but since it requires the presence of air, it gets it [air] via a connection called the eustachian tube that connects this space with the back of the nose," says Dr. Kim. "The nose, unlike the middle ear, is not a sterile space and can be infected by bacteria, virus and fungus that can subsequently track [travel] up the eustachian tube to enter the middle ear space."

Inner Ear Infection

Inner ear infections primarily involve symptoms of dizziness and hearing loss. These types of ear infections are rare and occur in adults, affecting the cochlea (hearing apparatus) and resulting in nerve hearing loss.

"The balance organ called the vestibule is also part of the inner ear. If this organ is involved, one can experience dizziness and hearing loss," says Dr. Kim.

Inner ear infections increase the risk of meningitis, a condition in which the protective membranes around the brain and spinal cord become inflamed, and can occur as an extension of a middle ear infection, according to Dr. Kim.