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Otitis Media (Middle Ear Infection) in Adults

Otitis Media (Middle Ear Infection) in Adults

Otitis media is another name for a middle ear infection. It means an infection behind your eardrum. This kind of ear infection can happen after any condition that keeps fluid from draining from the middle ear. These conditions include allergies, a cold, a sore throat, or a respiratory infection.

Middle ear infections are common in children, but they can also happen in adults. An ear infection in an adult may mean a more serious problem than in a child. So you may need additional tests. If you have an ear infection, you should see your healthcare provider for treatment. If they happen repeatedly, you should see an otolaryngologist (ear, nose, and throat specialist) or an otologist (ear subspecialist).

What are the types of middle ear infections?

Infections can affect the middle ear in several ways. They are:

  • Acute otitis media- This middle ear infection occurs suddenly. It causes swelling and redness. Fluid and pus become trapped under the eardrum (tympanic membrane). You can have a fever and ear pain.
  • Chronic otitis media- This is a middle ear infection that does not go away, or happens repeatedly, over months to years. The ear may drain (have liquid coming out of the ear canal). It can often be accompanied by a tympanic membrane perforation [link “tympanic membrane perforation” to the new Health Library page entitled “Tympanic Membrane Perforation”] and hearing loss. Usually chronic otitis media is not painful.
  • Otitis media with effusion- Fluid (effusion) and mucus build up in the middle ear after an infection goes away. You may feel like your middle ear is full. This can continue for months and may affect your hearing. This is also sometimes called serous otitis media.
  • Chronic otitis media with effusion- Fluid (effusion) remains in the middle ear for a long time. Or it builds up again and again, even though there is no infection. It may also affect your hearing

Who is more likely to get a middle ear infection?

You are more likely to get an ear infection if you:

  • Smoke or are around someone who smokes
  • Have seasonal or year-round allergy symptoms
  • Have a cold or other upper respiratory infection

What causes a middle ear infection?

The middle ear connects to the throat by a canal called the eustachian tube. This tube helps even out the pressure between the outer ear and the inner ear. A cold or allergy can irritate the tube or cause the area around it to swell. This can keep fluid from draining from the middle ear. The fluid builds up behind the eardrum. Bacteria and viruses can grow in this fluid. The bacteria and viruses cause the middle ear infection.

What are the symptoms of a middle ear infection?

Common symptoms of a middle ear infection in adults are:

  • Pain in 1 or both ears
  • Drainage from the ear
  • Muffled hearing
  • Sore throat 

You may also have a fever. Rarely, your balance can be affected.

These symptoms may be the same as for other conditions. It’s important to talk with your health care provider if you think you have a middle ear infection. If you have a high fever, severe pain behind your ear, or paralysis in your face, see your provider as soon as you can.

How is a middle ear infection diagnosed?

Your health care provider will take a medical history and do a physical exam. He or she will look at the outer ear and eardrum with an otoscope or an otomicroscope. These are lighted tools that let your provider see inside the ear. A pneumatic otoscope blows a puff of air into the ear to check how well your eardrum moves. If your eardrum doesn’t move well, it may mean you have fluid behind it.

Your provider may also do a test called tympanometry. This test tells how well the middle ear is working. It can find any changes in pressure in the middle ear. Your provider may test your hearing with an audiogram (hearing test) or tuning fork.

How is a middle ear infection treated?

A middle ear infection may be treated with:

  • Antibiotics, taken by mouth or as ear drops
  • Medication for pain
  • Decongestants, antihistamines, or nasal steroids
  • For chronic otitis media with effusion, an ear tube (tympanostomy tube) may help (see below)

Your health care provider may also have you try autoinsufflation. This helps adjust the air pressure in your ear. For this, you pinch your nose and gently exhale. This forces air back through the eustachian tube.

The exact treatment for your ear infection will depend on the type of infection you have. In general, if your symptoms don’t get better in 48 to 72 hours, contact your health care provider.

Middle ear infections can cause long-term problems if not treated. They can lead to:

  • Infection in other parts of the head
  • Permanent hearing loss
  • Paralysis of a nerve in your face

Occasionally, you may need CT scan or MRI to check for rare causes such as a cholesteatoma or tumors. If you have a middle ear infection that doesn’t get better, you should see an ear, nose, and throat specialist (otolaryngologist) or a specialized otologist.

Ear tubes

Sometimes fluid stays in the middle ear even after you take antibiotics and the infection goes away. In this case, your health care provider may suggest that a small tube (also called a tympanostomy tube) be placed in your ear. The tube is put at the opening of the eardrum. The tube keeps fluid from building up and relieves pressure in the middle ear. It can also help you hear better. This procedure is sometimes called a myringotomy. It is done more commonly in children but is also performed in adults. In adults, it is a routine procedure that takes under 5 minutes in the office. The tubes usually fall out on their own after 6 months to a year. Ear tubes can be placed by an otolaryngologist or a specialized otologist.