I always have a bit of explaining to do when a patient tells me they have been diagnosed with an “ear infection” by their primary care doctor. Because while there are multiple types of ear infections that occur in the outer, middle, or inner ear, my patients often do not understand the differences – or that differences exist at all.

Ear infections can develop quite rapidly, though they often do not disappear quickly. They can be bacterial or viral and can happen in multiple spots throughout the ear. With all this nuance, it makes sense that patients (and even their primary care physicians) might get confused. So, let’s take a look at the basics of ear infections, including types of ear infections and why some are harder to diagnose and treat than others.

Viral Ear Infections vs. Bacterial Ear Infections

Anytime someone experiences ear pain, a visit to a medical doctor is warranted.  However, not all ear pain is caused by an ear infection, and diagnosing an ear infection correctly is not as cut and dry as it might seem.

Ear infections can be caused by a virus or by bacteria. It can be hard to pinpoint the exact cause, but typically, a bacterial ear infection will come with a high fever while a viral ear infection will not – though fevers can happen with viral infections, too.

The differences between viral and bacterial ear infections also extend to how they’re treated. True bacterial infections can be treated with antibiotics, and frequently, patients with bacterial infections will experience relief from their symptoms within 24 to 48 hours after starting treatment. Viral infections will not respond to treatment with antibiotics and a patient will usually just be advised to manage symptoms until the infection clears up on its own in about one to two weeks.

Ear Anatomy and How Infections Happen

Understanding ear infections requires an awareness of the anatomy of the entire ear. That’s because the cause of an ear infection varies based on where it’s occurring, as does the proper course of treatment.

External Ear Infections

An external ear infection happens in the part of the ear that is closest to the ear, or “pinna,” on the outside of our head. The tube you can stick your finger in is the external ear canal, and it ends at the eardrum, or “tympanic membrane,” at the end of the tube.

The outer 2/3 of the ear canal is made of cartilage, and the inner 1/3 of the ear canal is a bony tube covered by skin. If you look at a human skull, you will see the holes for the bony parts of the external ear canals on the sides of the skull.

An ear infection in the outer ear is extremely painful. With infection, the skin and tissue of the external ear canal can swell, and sometimes they completely shut. Treating this kind of infection can require a “wick,” a skinny piece of cotton soaked in medication that is threaded down into the canal.

Sometimes, the external ear can have a fungal infection, which can be difficult to treat as a single spore of fungus can cause the infection to return.  While ear wax does have antibiotic properties, it can only do so much.

Middle Ear Infections

The middle ear is located on the opposite side of the eardrum. It is a small pocket of air with the bones of the middle ear suspended across the space with muscles, much like a suspension bridge.

The job of the middle ear bones, one of which is embedded in the ear drum, is to take sound vibrations that hit the eardrum into the inner ear. The unique shape and size of the middle ear bones help amplify the sound vibrations from the eardrum so that they can travel into the inner ear. The only opening into the middle ear space is through the “Eustachian tube” (u-STAY-shun).  The Eustachian tube’s job is to allow fresh air to enter the middle ear space. The tube starts inside the back of the throat, just above where the soft palate ends.

When you have sinus issues, the Eustachian tube may not open like it normally would when you swallow. This can result in the development of an air pressure vacuum in the space behind the eardrum. If the tube cannot open, the vacuum can pull the mucus lining of the middle ear space off the walls of the middle ear, where it builds up and causes infection.

Sometimes, a doctor can see this line of fluid by looking at your eardrum with an otoscope. You might be able to feel it sloshing around in your ear, too. This fluid is a great medium for bacteria to grow in. From there, bacteria can travel up the Eustachian tube and multiply rapidly in the fluid in the middle ear space, resulting in a middle ear infection.

Middle ear infections can develop rapidly over a period of hours and can be quite painful due to the pressure of the resulting infection and pus as your body tries to fight the infection. Left untreated, the pressure from the infection can rupture the eardrum, and the goo from the middle ear will drain into the external ear canal. There can be times when the eardrum does not rupture, but the infectious material becomes very thick instead. All of this affects how sound vibrations travel through the bones of the middle ear and can cause temporary hearing loss because the sound energy is absorbed by the middle ear goop instead of traveling like it normally would through the middle ear bones.

Children’s Eustachian tubes have less of an incline than adults, and their adenoid glands sit right above where the Eustachian tube opens in the sinuses. As a result, children are more prone to having middle ear infections than adults. Frequent middle ear infections can affect a child’s ability to develop normal speech and language skills. This can contribute to learning problems, so addressing them as early as possible is important.  A common treatment for repeated middle ear infections is the placement of a plastic tube in the eardrum to provide a secondary source for air to flow through the middle air space.

Inner Ear Infections

Infections of the inner ear tend to be the hardest to diagnose and treat.

The inner ear is a sealed cavity inside the temporal bone and, on diagrams of the ear, often appears like a snail shell with loops attached. The loops, called the “semicircular canals,” are part of our balance system, known as the “vestibular system,” and the snail shell part of the inner ear is called the “cochlea,” which forms the hearing part of the inner ear.

Because the semicircular canals and the cochlea share fluid, inner ear infections are frequently associated with issues with balance and hearing. Infections of the inner ear can also result in dizziness and vomiting, an inability to focus your eyes, or strange hearing experiences like buzzing or roaring tinnitus. Distortions in your hearing or full hearing loss are possible as well.

The inner ear is a sealed structure, so bacterial infections are less common in this area. Instead, viral infections tend to be responsible for infections in the inner ear, including viruses that cause flu and viruses in the herpes family, such as Epstein-Barr or shingles.

If you are experiencing problems with your balance and/or hearing, and especially if you are experiencing sudden hearing loss, it’s important to see a doctor quickly. People with infections of the inner ear can have lasting and ongoing issues with their hearing and balance that do not get better after the infection resolves, which can be very frustrating. That being said, there is evidence that starting treatment sooner rather than later can result in better outcomes and a return of hearing function. Treatment for inner ear infections often includes steroids and anti-inflammatory drugs.

Worried About an Ear Infection? Schedule an Appointment with a Hearing Care Professional

Hopefully, this information will be of use to you in understanding different types of ear infections, their causes, and their symptoms. Remember that all ear pain, particularly ear pain associated with sudden hearing loss, should be taken seriously. If you have any worrying symptoms, find and schedule an appointment with a local hearing care professional as soon as possible. If you’re in the Lafayette, IN, area, book a consultation with us at Lafayette Hearing Center. Quick action could help you preserve your hearing and prevent symptoms from progressing into something even more serious.

About the author.
Dr. Susan Taulia, Au.D.

Lafayette Hearing Center – Lafayette, IN

Dr. Susan Taulia’s doctorate is from the University of Florida, and she has been in practice since 1995. She specializes in the diagnosis of hearing disorders, and the fitting of hearing technology to treat tinnitus, hearing loss, and Sound Voids®. Dr. Taulia will take the time to understand your unique communication needs. She has tinnitus herself, and a family history of hearing loss. Dr. Taulia knows that tinnitus and any hearing problem not only affects you, but every person in your life. Come see how Dr. Taulia can improve your hearing! Hablo español y, aunque no es perfecto, podemos entendernos. Espero conocerle a usted, y a su familia. Dr. Taulia’s practice is HearingLoss.com certified, further showcasing her expertise and commitment to excellence in the field of hearing care. Learn more about Dr. Taulia and Lafayette Hearing Center.

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