Middle Ear Infection (Otitis Media) in Adults

Middle ear infections, also called otitis media, are most common in infants and young children, but adults also develop them.

And while most infections go away on their own, in some cases, a middle ear infection in an adult can indicate a more serious problem than one in a child or baby. 

To help you stay healthy, in this article, I’ll describe the different types of middle ear infections in adults as well as their causes and symptoms.

I’ll also cover the diagnosis process and treatment options available.

Finally, I’ll describe which adults are more at risk for middle ear infections, the possible complications of a middle ear infection, and how best to prevent middle ear infections.

Types of Middle Ear Infections in Adults

A middle ear infection is an infection or inflammation of the area behind your eardrum.

This can prevent fluid from draining from the middle ear, causing pain, discomfort, and hearing problems.

You can also have an inner ear or outer ear infection (also called swimmer’s ear), but middle ear infections are the most common type of ear infection.

The main types of middle ear infections are:

Acute otitis media

Acute otitis media refers to a middle ear infection that comes on quickly.

It can cause redness, swelling, fever, and ear pain, and often results in fluid and pus getting trapped under the eardrum.

In some cases, you may also experience temporary hearing impairment.

Chronic otitis media 

Chronic otitis media refers to a middle ear infection that does not go away or happens multiple times over the course of several months or years.

It can cause fluid to drain from the ear canal, and may be accompanied by tympanic membrane perforation (a ruptured eardrum) and hearing loss. 

Otitis media with effusion

In some cases, fluid (also called effusion) and mucus build up and remain in the middle ear after an infection clears.

This can happen because of a dysfunction or noninfectious blockage of the eustachian tubes.

Otitis media with effusion, sometimes called serous otitis media, can feel like your ear is full and persist for several months, possibly affecting hearing. 

Chronic otitis media with effusion

Chronic otitis media with effusion is when fluid remains in the middle ear for a long period of time or builds up persistently even though there is no bacterial or viral infection.

Similarly to otitis media with effusion, it can affect your hearing.

Causes

Any bacterial or viral infection that prevents fluid from draining from the middle ear can cause a middle ear infection.

More specifically, conditions that can cause a middle ear infection include: 

• Allergies
• A common cold or flu 
• Sore throat
• Respiratory infection

Eustachian tubes and adenoids can affect middle ear infections too.

The eustachian tubes are two narrow tubes that connect the middle ear and upper part of the throat.

These tubes (one located near each ear) work to regulate air pressure, refresh air, and drain secretions from the middle ear.

Swollen eustachian tubes can cause fluids to build up in the middle ear, leading to an infection. 

Adenoids, two small pads of tissues located in the back of the upper part of the throat near the eustachian tubes, can also block the eustachian tubes when swollen, causing a middle ear infection. 

Symptoms in Adults

Common symptoms of middle ear infections in adults include:

• Earache or pain in one or both ears
• Drainage from the ear
• Muffled hearing
• Sore throat

Less common symptoms include:

• Fever
• Impaired balance

If you have a high fever, severe pain behind your ear, or facial paralysis, reach out to your healthcare provider as soon as possible.

A middle ear infection in an adult can be a sign of a more serious problem, which is why it’s important to see your healthcare provider for treatment.

If you experience chronic ear infections, talk to your primary care provider, an otolaryngologist (ear, nose, and throat specialist), or an otologist (ear subspecialist).

Diagnosis 

Most providers will diagnose a middle ear infection with a physical exam of the outer ear and eardrum with lighted tools (such as an otoscope or an otomicroscope).

Your doctor may also use a pneumatic otoscope to blow a puff of air into your ear to see how well your eardrum moves in response.

If your eardrum doesn’t move well, this may be a sign of fluid blocking the middle ear.

In some cases, your doctor may also perform a test called tympanometry, which can identify pressure changes in the middle ear.

Finally, your doctor might want to do a hearing test with a tuning fork or audiogram. 

Treatment 

Many middle ear infections go away on their own within a few days, but in some cases—especially if you experience recurrent middle ear infections—your doctor may prescribe medication to help clear the infection or manage pain and other symptoms. 

To determine the best treatment options for you, your healthcare provider will consider several things, including:

• The type and severity of the ear infection
• The frequency of your ear infections
• How long you’ve had the current infection
• Your age and other risk factors
• Whether or not your hearing is affected

Depending on these factors, your middle ear infection may be treated with:

• Antibiotics: Your doctor may prescribe antibiotics such as cephalexin (Keflex) or trimethoprim-sulfamethoxazole (Bactrim) to be taken orally or by ear drops.

• Pain medication: Talk to your doctor about medication to alleviate any pain. They may recommend over-the-counter (OTC) options like acetaminophen (Tylenol) or ibuprofen (Advil). 

• Autoinsufflation: Your doctor may ask you to try this method to adjust the air pressure in your ear. They will guide you on how to pinch your nose and gently exhale.

• Decongestants, antihistamines, or nasal steroids: These can help reduce swelling in the mucous membranes and open up the eustachian tubes.

• Anesthetic drops: These drops can help relieve pain in the eardrum if there is no hole or tear in it.

• Tympanostomy tube: If you have chronic otitis media with effusion, your provider may suggest placing a small tube in your ear to keep fluid from building up and help relieve pressure in the middle ear. These tubes usually fall out on their own within 4-18 months.

Risk Factors

As an adult, you’re also more at risk for a middle ear infection if you:

• Smoke or are in close regular contact with someone who smokes
• Have seasonal allergies
• Have a common cold or other upper respiratory infection

Complications

Complications from middle ear infections are rare. However, when left untreated, middle ear infections can cause long-term problems such as:

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

Prevention

Preventing middle ear infections, especially those caused by bacterial or viral infections, isn’t always possible.

Still, you can take the following steps to reduce your chance of infections:

• Don’t smoke: Also try to avoid secondhand smoke to reduce or eliminate your exposure to this trigger.

• Practice good hygiene: Wash your hands well and often to help prevent the spread of germs, some of which can cause ear infections.

• Get vaccinated: Staying up to date with your vaccines can help prevent ear infections.

• Manage your allergies: If allergies trigger your ear infections, talk with your doctor about the best preventive measures, including medication.

When to See a Doctor

If you notice persistent middle ear infection symptoms that don’t resolve on their own, call a healthcare professional immediately.

If left untreated, the infection could lead to serious long-term complications.

Your doctor can determine what is causing your discomfort and work with you to develop the best treatment plan.

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