Ear infections in adults - acute

Definition

Otitis media is a type of ear infection. It is caused by swelling and infection of the middle ear. The middle ear is located just behind the eardrum.

An acute ear infection starts over a short period and is painful. Ear infections that last a long time or come and go are called chronic ear infections.

While ear infections are much more common in children, they also occur in adults. This  article is about acute otitis media in adults.

Alternative Names

Otitis media in adults – acute; Infection - inner ear - adult; Middle ear infection in adults - acute

Causes

The eustachian tube runs from the middle of each ear to the back of the throat. Normally, this tube drains fluid that is made in the middle ear. If this tube gets blocked, fluid can build up. This can lead to an infection. Ear infections are less common in adults because their eustachian tubes are larger and tend to drain better. A child's eustachian tubes are smaller and more easily clogged.

Anything that causes the eustachian tubes to become swollen or blocked may lead to more fluid buildup in the middle ear behind the eardrum. Colds and sinus infections are the most common cause of ear infections in adults.

Getting water in your ear can cause an infection in the outer ear and ear canal (swimmer's ear). However, this cannot cause a middle ear infection unless you have a hole in your eardrum.

Symptoms

Symptoms of an acute ear infection in adults include:

• Ear pain
• Fullness in the ear
• Feeling of general illness
• Nasal congestion
• Cough
• Lethargy
• Vomiting
• Diarrhea
• Hearing loss in the affected ear
• Drainage of fluid from the ear
• Loss of appetite

The ear infection may start shortly after a cold. All acute ear infections involve fluid behind the eardrum. Sudden drainage of yellow or green fluid from the ear may mean the eardrum has ruptured.

Exams and Tests

Your health care provider will take your medical history and ask about symptoms.

Your provider will look inside the ears using an instrument called an otoscope. This exam may show:

• Areas of marked redness
• Bulging of the tympanic membrane (eardrum)
• Discharge from the ear
• Air bubbles or fluid behind the eardrum
• A hole (perforation) in the eardrum

Your provider might recommend a hearing test if you have a history of ear infections.

Treatment

Your provider will likely prescribe antibiotics to treat the infection. Here are steps to help relieve pain and help the ear heal:

• Apply a warm cloth or warm water bottle to the affected ear.
• Use over-the-counter pain relief drops for ears. Or ask your provider about prescription eardrops to relieve pain.
• Take over-the-counter medicines such as ibuprofen or acetaminophen for pain or fever.

ANTIBIOTICS

Most ear infections in adults are caused by bacteria, so your provider will prescribe an antibiotic.

If antibiotics are prescribed, it is important to take them as directed and to take all of the medicines. Do not stop the medicine when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your provider. You may need to switch to a different antibiotic.

Side effects of antibiotics may include nausea, vomiting, and diarrhea. Serious allergic reactions are rare, but may also occur.

Outlook (Prognosis)

Most often, an ear infection is a minor problem that gets better with treatment. Recurring ear infections in adults are uncommon.

Possible Complications

In rare cases, a more serious infection may develop, such as:

• Tearing of the eardrum
• Spreading of infection to nearby tissues, such as infection of the bones behind the ear (mastoiditis) or infection of the brain membrane (meningitis)
• Chronic otitis media
• Collection of pus in or around the brain (abscess)

When to Contact a Medical Professional

Contact your provider if:

• You have swelling behind the ear.
• Your symptoms get worse, even with treatment.
• You have a high fever or severe pain.
• Severe pain suddenly stops, which may indicate a ruptured eardrum.
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or twitching of the face muscles.

Prevention

You can reduce your risk of ear infections with the following measures:

• Wash your hands and take other steps to help protect yourself from upper respiratory infections such as a cold, the flu, or COVID-19.
• Avoid smoking and exposure to tobacco smoke.
• Make sure your immunizations are up to date. The pneumococcal vaccine prevents infections from the bacteria that most commonly cause acute ear infections and many respiratory infections.

References

Shin J, Bellmunt AM. Otitis media with effusion. In: Francis HW, Haughey BH, Hillel AT, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 8th ed. Philadelphia, PA: Elsevier; 2026:chap 193.

Tahtinen PA, Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Blaser MJ, Cohen JI, Holland SM, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 10th ed. Philadelphia, PA: Elsevier; 2026:chap 63.