Ear infections: Causes and treatment

Ear infections are quite common, especially in children but adults can get them too. There are different parts of your ears that can get attacked by bacteria, viruses, or fungi. You may blame your immune system but there are more reasons behind these infections. Even something as simple as water exposure can affect your ears. Passive smoking can also be one of the reasons why your ears are infected. That’s why you should stay away from cigarette smoke as much as you can. Like causes, there are also a lot of options to treat ear infections and prevent them as well.

What are ear infections?

“Ear infections occur when bacteria, viruses, or fungi invade the ear, and cause inflammation,” says ENT expert Dr Lalit Mohan Parashar. They can affect different parts of the ears:

1. Otitis externa (outer ear infection)

This is commonly called swimmer’s ear and affects the ear canal. “It usually starts as a result of bacterial or fungal overgrowth and is often a consequence of retained moisture,” says ENT expert Dr Shashidhar TB. This can also lead to redness, swelling, pain, and sometimes discharge.

2. Otitis media (middle ear infection)

“This is the most common type of ear infection, especially in children, and is basically caused by inflammation and the accumulation of fluid behind the eardrum,” says Dr Shashidhar. It can have different durations: Acute, which is sudden onset and usually short duration, and chronic which is prolonged or recurring. Fever and ear pain are two of the common symptoms.

3. Otitis interna (inner ear infection)

Also known as labyrinthitis, this is an uncommon condition where the inner ear structures are inflamed. This infection happens due to a virus, such as influenza. “It can lead to dizziness, nausea, and sometimes hearing loss,” says Dr Shashidhar.

Such infections are particularly common in children but can also affect adults. Approximately 50 percent of all kids will have at least one ear infection by the time they turn two, according to research published in JAMA Pediatrics in 2020. As for grown-ups, ear infections, especially middle ear infections, occur at a rate of about 5.3 per 1,000 adults in one year, as per research published in Family Practice in 2021.

What are the causes of ear infections?

1. Immature immune system

Ear infections, especially in children, may have to do with their immune system. Their immune systems are still developing, making it harder for them to fight off bacteria, viruses, or fungi. As a result, they are more susceptible to infections, including those in the ear.

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2. Shorter and more horizontal eustachian tubes

“The eustachian tubes, which connect the middle ear to the throat, are shorter and more horizontally aligned in children,” says Dr Parashar. This structure makes it easier for bacteria and viruses from the throat to enter the middle ear, leading to infection.

3. Upper respiratory infections

Respiratory infections such as colds and sinus infections can be bad for your ears. They can cause swelling and block the eustachian tubes. This blockage prevents fluid from draining out of the middle ear, creating a breeding ground for bacteria, and leading to ear infections.

4. Allergies

Allergies can lead to swelling in the nasal passages and eustachian tubes, causing fluid buildup in the middle ear and increasing the risk of infection. During a 2023 study, published in Cureus, it was found that 49.2 percent of participants with allergic rhinitis had middle ear infection. Allergic rhinitis is the inflammation of the inside of the nose that happens due to an allergen.

5. Bottle feeding

Babies who drink from bottles while lying flat are more prone to fluid entering the eustachian tubes, which can lead to ear infections. “Breastfeeding, especially in an upright position, reduces this risk,” says Dr Parashar.

6. Exposure to smoke

Second-hand smoke irritates the respiratory system and weakens immunity, making infections more likely. Exposure to cigarette smoke is a major risk factor for Otitis media, according to research published in Scientific Reports in 2021.

7. Exposure to water

Prolonged exposure to water, such as during swimming or taking a shower, can trap moisture in the ear canal. “This encourages bacterial or fungal growth, particularly in the outer ear or swimmer’s ear, leading to an infection,” says Dr Parashar.

8. Chronic condition

Conditions like diabetes can weaken the immune system, making people more vulnerable to infections. Diabetes, a condition that happens when the blood sugar becomes very high, is the most common risk factor for otitis media, as per research published in The Journal Of International Advanced Otology in 2023.

9. Injury to the ear canal

Do you use cotton swabs to clean your ears? They may do more damage than good. Using cotton swabs or inserting other objects can damage the delicate lining of the ear canal, allowing bacteria or fungi to enter and cause ear infections.

How to treat ear infections?

1. Medical treatment

• Pain relievers: “Over-the-counter pain medications like ibuprofen or acetaminophen help alleviate ear pain and reduce fever,” says Dr Parashar.
• Antibiotics: For bacterial infections, especially those that are severe or persistent, you may be told to have antibiotics. These can be oral medications or ear drops. Oral antibiotics may be more effective than antibiotic-corticosteroid eardrops in treating ear infections, as per research published in Family Practice in 2024.
• Antifungal medications: For fungal infections in the ear, antifungal ear drops are typically recommended.

2. Home remedies

• Warm compress: Applying a warm compress to the affected ear can help reduce pain and swelling by improving blood circulation.
• Hydration: “Drinking plenty of fluids helps thin mucus, making it easier for the eustachian tubes to drain fluid from the middle ear,” says Dr Parashar.
• Elevated head position: Sleeping with your head slightly elevated helps fluid in the ear drain more effectively, reducing pressure and pain.

3. Drainage procedures

In cases of chronic or severe ear infections, a doctor may perform minor surgical procedures:

• Myringotomy in which a small incision is made in the eardrum to drain fluid.
• Tympanostomy tubes that involve inserting small tubes into the eardrum to prevent fluid buildup and reduce the risk of recurrent infections.

How to avoid ear infections?

1. Maintain hygiene

Clean your ears gently without inserting anything like cotton swabs into your ear canal. You can use warm, damp cloth to clean your ears or use ear drops without hurting them. Also, keep your ears dry, especially after swimming or taking a bath.

2. Prevent respiratory infections

Practice good hand hygiene to reduce the risk of colds and flu, which can lead to ear infections. Apart from good hygiene habits, stay away from people with cold or respiratory infections, especially if your immune system is weak. It won’t take long for you to catch a cold as well.

3. Manage allergies

“Use antihistamines or nasal sprays as prescribed by your doctor,” says Dr Parashar. These can help to reduce inflammation in the nasal passages and eustachian tubes. Once the inflammation gets reduced, you wouldn’t have to worry about ear infections.

4. Avoid second-hand smoke

Cigarette smoke not only has adverse effects ok your lungs but also your ears. Ensure your home environment is free from smoke and other pollutants. Stay away from second-hand smoke if you love your health and don’t want ear infections to bother you.

5. Breastfeed when possible

Breastfeeding may not always be possible for you but do it whenever you can. “Breastfeeding strengthens a baby’s immune system, reducing the risk of infections,” says Dr Parashar. It will help to avoid ear infections and keep your baby healthy.

6. Vaccinations

Ensure your child is vaccinated against flu and streptococcus pneumoniae bacteria that are often found in the throats and noses of people. These shots are a must as they can help to lower the likelihood of getting ear infections in children.

7. Address deficiencies

Whether it is a child or an adult, nutritional deficiencies need to be addressed. “Deficiencies in vitamins like D, C, and zinc need to be addressed to strengthen the immune system,” says Dr Parashar. Doing this can also help to prevent future ear infections.

Understand the causes then go for treatment of ear infections to ensure quicker recovery. Manage allergies, or chronic health conditions like diabetes and maintain good ear hygiene to reduce the risk of developing ear infections.