Your ear has been itchy ever since you swam in that smelly pool. Your toddler has been tugging on their ear for the last week. Your elderly mother, who’s just recovered from pneumonia, has ear pain and is feeling dizzy. Are these all signs of ear infections?

They can be. Different types of ear infections have varying symptoms and affect people in different ways. Read on for answers about ear pain, itchy ears, the difference between viral and bacterial ear infections, and more.

What causes an ear infection?

Ear infections start when fluid containing bacteria or viruses get trapped in your ear. Over time, these trapped germs can grow into an ear infection.

These germs often come from other illnesses that cause swelling and congestion in your nasal passages and throat. That’s why symptoms of ear infections can show up 2-7 days after the beginning of a cold or upper respiratory infection. But these germs can also come from water that you swim or bathe in.

Are ear infections contagious?

No, but viruses and bacteria that cause ear infections can spread from one person to another. In other words, you can’t give someone your ear infection, but you can spread the germs that caused it.

Can an ear infection be a sign of COVID-19?

There’s no clinical data that shows a connection between ear infections and COVID-19. However, it’s possible that newer strains of COVID-19 may affect people in different ways.

Although COVID-19 and ear infections can cause fever and headache, with COVID-19 you don’t usually get ear pain, hearing loss or fluid drainage from the ear. Also, keep in mind that it’s possible to get the flu and COVID-19 at the same time – and viral ear infections can sometimes be caused by the flu.

What are the symptoms of an ear infection?

Fluid and germs can get stuck in the outer, inner or middle part of the ear, causing different types of ear infections and symptoms.

Outer ear infections

An external ear infection is often referred to as swimmer’s ear. It’s possible for bacteria to grow in the water that’s left in your ear after swimming or bathing. This normally isn’t a problem. But, if you have a scratch or sore on your ear, it can lead to a bacterial infection.

Common outer ear infection symptoms

  • Redness on the outer ear
  • Itchiness
  • Ear pain and congestion
  • Yellow or yellow-green discharge
  • Swollen ear or neck
  • Hearing changes or loss
  • Fever, usually between 100-104 degrees Fahrenheit

Inner ear infections

This type of ear infection, also known as labyrinthitis, happens when your inner ear gets swollen or irritated because of a cold, flu, allergies or another condition such as meningitis.

Common inner ear infection symptoms

  • Dizziness, nausea and vomiting
  • Ear pain
  • Balance issues
  • Hearing changes or loss

Middle ear infections

Middle ear infections are known as otitis media. They are the most common type of ear infection, especially in children. Middle ear infections usually happen when the Eustachian tubes that connect your ears to your throat are swollen from a cold, flu or allergies.

When your Eustachian tubes are working normally, they drain fluid from the middle ear. But if they’re swollen because you’re sick, the fluid can’t drain. Instead, that fluid collects behind your eardrum and makes it more likely for germs to grow into an ear infection.

It’s also possible for swollen adenoids (lumps of tissue in the back of the nose) to prevent ear fluid from draining. If the adenoids are enlarged or irritated, they can block the opening of the Eustachian tubes.

Common middle ear infection symptoms

  • Ear pain
  • Fever, usually between 100-104 degrees Fahrenheit
  • Headaches
  • Fluid coming from the ear
  • Hearing changes or loss
  • Balance issues
  • Sore throat

Sometimes people can have symptoms of a middle ear infection such as hearing loss without actually having an infection. This is caused by inflammation and fluid buildup in the middle ear. Hearing usually goes back to normal once the fluid drains – which could take weeks. Learn about hearing tests and when to get them.

How can I tell if my infant or child has an ear infection?

If your little one has an ear infection, they won’t be able to tell you in words, but you’ll likely be able to tell through their actions. Chances are, they’ll:

  • Be fussy
  • Pull at their ears and cry
  • Have trouble sleeping
  • Have a fever, usually between 100-104 degrees Fahrenheit

How do you know if an ear infection is viral or bacterial?

It can be difficult to tell, at least in the beginning. If you or your child is recovering from a virus (cold or flu), it’s probably more likely you’re dealing with a viral ear infection. If strep throat or pneumonia has been in the house, there’s a greater chance that it’s bacterial. But that’s not always the case.

Symptoms are similar with viral and bacterial infections. One difference is you have a higher fever with a bacterial ear infection. However, fevers can also happen with viral infections.

Often, it’s a bit of a waiting game. If the ear infection goes away on its own within a week or so, you can assume it was caused by a virus. If it isn’t improving after a week, it might be a bacterial infection and you should definitely seek medical treatment.

Who is most likely to get an ear infection?

Anyone can get an ear infection. But you’re more likely to get ear infections if you have allergies or other conditions that cause congestion. You may also get more ear infections if you have a weakened immune system and are often sick.

A person’s anatomy can also increase their chance of getting an ear infection. That’s why ear infections are more common in young children and in people with birth defects or medical conditions, such as cleft palate or Down syndrome.

Ear infections in children

Why do children get ear infections?

Infants and young children between 3 months old and 3 years old are much more likely to get ear infections than adults. In fact, most children will have at least one ear infection. The main reasons are:

  • Differences in Eustachian tubes. These tubes in your ears are shorter and narrower when you’re younger, so it’s easier for them to become blocked. Additionally, the tubes in infants and young children are usually more horizonal than those in adults which means that it’s harder for fluid to drain.
  • Their developing immune system. When infants are about 6 months old, they start losing some of the immunity they were born with. At the same time, babies start becoming more social, sharing both toys and germs. Breastfeeding is one effective way to help strengthen your child’s immune system.

What can increase your child’s risk for ear infections?

  • Being exposed to cigarette smoke. Cigarette smoke irritates the Eustachian tubes and causes them to swell.
  • Lying flat while bottle feeding. Milk or formula can travel up the Eustachian tubes, causing irritation and swelling.
  • Pacifier use. Using a pacifier can affect how the Eustachian tubes work. But using a pacifier can be helpful in safe sleep for babies and preventing sudden infant death syndrome. So, talk to your doctor about when your baby should stop using a pacifier – most of the time it’s when they’re about 6 months old.
  • Being in a large childcare center. More kids mean more germs, making it more likely that your child could get repeat ear infections.

Ear infections in adults

What risk factors make certain adults more likely to get an ear infection?

Adults with weakened immune systems and certain medical conditions may be more likely to get ear infections. For example, if you have diabetes, it can cause an inflammatory response throughout your body – including your middle and inner ear. Having skin conditions like eczema or psoriasis may also increase the chance that you get an outer ear infection.

How long do ear infections last?

In many cases, ear infections clear up in a couple of weeks without treatment. But some ear infections can last for months.

So why do some ear infections last longer than others? The reasons include your health, the location of the infection and what’s causing the infection. Inner ear infections tend to stick around longer than infections of the middle or outer ear. And infections caused by bacteria usually last longer than ones caused by viruses.

When is an ear infection considered to be chronic?

If an ear infection lasts for more than three months, it’s considered chronic. If chronic ear infections aren’t treated, it can lead to hearing loss and other serious problems. In children, chronic ear infections can affect their ability to achieve developmental milestones, like walking and talking.

Is a chronic ear infection curable?

If your child has an ear infection for a few months and it’s affecting their ability to hear, your doctor may recommend a minor surgery to put in ear tubes for chronic ear infections.

During ear tube surgery, an ear, nose and throat (ENT) doctor inserts small plastic or metal tubes into the eardrum. These tubes help drain the built-up fluid that can cause ear infections. Ear tubes usually fall out on their own within about a year.

What are recurring ear infections?

People of all ages can get frequent ear infections, but they are especially common in children – about 25% of children experience repeat ear infections. If you or your child has three or more ear infections in a six-month period or four within one year, it’s a good idea to talk to your doctor about treatment options.

Are recurrent ear infections curable?

Your doctor may recommend ear tube surgery to make it less likely for you or your child to get future ear infections.

Your doctor may also suggest a tonsillectomy to remove infected tonsils and adenoids. This surgery involves removing lumps of tissue from the back of your nose and throat. Getting a tonsillectomy may make it easier for fluid to drain from your ears, reducing the chance of trapped fluid that can cause an ear infection. A tonsillectomy is usually only recommended when antibiotics and ear tubes don’t work.

What should I do about an ear infection?

If it’s only been a couple of days and the only symptom has been ear pain, you don’t need to head to the doctor right away. Because many ear infections go away on their own, it’s likely your doctor will want to wait and see how the symptoms improve before providing prescription medicines.

In the meantime, focus on getting lots of rest. Sleeping strengthens the immune system and helps the body fight off infections and other sickness.

If the ear infection is causing pain or discomfort, there are treatments for ear infections you can try at home. One of the simplest is using a warm compress to dull the pain. Just soak a washcloth in warm water, wring out the excess water and then hold it against the infected ear for up to 20 minutes. If it helps, reapply the compress throughout the day.

If your child is over 3 months old, an over-the-counter medication like acetaminophen (Tylenol) can also help with the pain – just make sure you’re using an age-appropriate dose. If you have questions, contact your doctor or nurse line.

When should I go to the doctor for an ear infection?

While many ear infections can be treated at home, some need medical attention. You’ll want to talk to a doctor or nurse if:

  • Your baby has a fever, especially if they are younger than 3 months old, or if your older baby’s temperature is above 102 degrees Fahrenheit.
  • The ear infection symptoms aren’t getting better after a couple of days.
  • There’s fluid draining from the ear.
  • You or your child is experiencing changes or loss of hearing.
  • The infection has lasted for more than six weeks.
  • You or your child is experiencing frequent or recurrent ear infections.

However you want to talk to us, we’re all ears

We’re here to make sure you get the care you need, day or night. Here are care options that may work based on your needs:

Nurse Line

If you’re wondering what to do about your baby’s fever or how to manage minor ear infection symptoms, a great place is to start is with the HealthPartners CareLine. Our members and patients can call us 24/7 day at 800-551-0859 or 952-993-4665.

Virtuwell visit

You can start an online Virtuwell visit any time, day or night to get an ear infection diagnosis and treatment plan for yourself or a child over age 5. In general, the doctor will prescribe a treatment plan that’s a combination of over-the-counter (OTC) pain relievers. In some cases, they’ll prescribe antibiotics for adults. They’ll also prescribe kids antibiotics for swimmer’s ear.

In-person or video visit with your primary care doctor

You can also schedule a virtual appointment with the doctor that usually cares for you or your child. They’ll have the best information about your family’s health and what treatments may be appropriate. If necessary, your child’s primary care doctor can prescribe antibiotics and recommend additional treatments.

Keep in mind that if it’s only been a couple days since the ear infection started, you may not get a prescription for antibiotics. Your doctor will likely recommend treating the ear infection with OTC pain relievers and scheduling another appointment after a week or so. If you start with a video visit, it’s also possible that the doctor may want to see you or your child in person.