Ear Infections

Ear infections are one of the most common reason for visiting a physician. These can occur in adults and children and can greatly vary in severity and cause. At MUSC we see and evaluate hundreds of children and adults every year for ear infections. The majority can be treated with medical therapy, but surgery is sometimes indicated. The particular treatment varies based on the exact cause of the infections. We are equipped to provide the most up to date diagnostic testing and treatment for all causes of ear infections.

Types Of Ear Infections

Outer Ear Infections (Otitis Externa) 

Otitis externa, also called swimmer's ear, is an inflammation, irritation, or infection of the external ear canal. The ear canal is the outer ear between the opening of the ear and the eardrum. When water remains trapped in the ear canal, bacteria or fungi can grow. Otitis externa is a painful condition that commonly affects swimmers. This is known as "swimmer's ear."

What causes swimmer's ear?

Many different factors can increase your chance of developing swimmer's ear. Besides trapped water, other possible causes of this infection include:

  • Being in warm, humid places
  • Harsh cleaning of the ear canal
  • Injury to the ear canal
  • Dry ear canal skin
  • Foreign body in the ear canal
  • Excess ear wax
  • Eczema and other forms of dermatitis

What are the symptoms of swimmer's ear?

The following are the most common symptoms of swimmer's ear:

  • Redness of the outer ear
  • Itching in the ear
  • Pain, especially when touching or wiggling the ear lobe, which may spread to the neck, face, or side of the head
  • Drainage from the ear
  • Swollen glands in the upper neck or around the ear
  • Swollen ear canal
  • Muffled hearing or hearing loss
  • Full or plugged-up feeling in the ear
  • Fever

The symptoms of swimmer's ear may look like other medical conditions or problems. Always consult your health care provider for a diagnosis.

How is swimmer's ear diagnosed?

Swimmer's ear may be diagnosed with a complete medical history and physical exam. Your health care provider may use an otoscope, a lighted instrument that helps to examine the ear and to aid in the diagnosis of ear disorders. This will help your provider know if there is also an infection in the middle ear. Although this infection usually does not occur with swimmer's ear, some people may have both types of infections. Your health care provider may also take a culture of the drainage from the ear to help determine proper treatment.

Treatment of Swimmer's Ear

Swimmer's ear, when properly treated by a health care provider, usually clears up within 7 to 10 days.

  • Treatment may include
  • Antibiotic eardrops
  • Corticosteroid eardrops (to help decrease the swelling)
  • Pain medication, your provider will ask you questions about how severe your ear pain is
  • Keeping the ear dry, as directed by your health care provider

Your health care provider will give you instructions on how eardrops should be applied. It is important to follow the instructions so that the proper dose of eardrops is delivered.

Preventing Swimmer's Ear

The following are some hints to help prevent swimmer's ear:

  • Use ear plugs for swimming or bathing.
  • After swimming, tilt your head to each side to help drain water.
  • You may also use a hair dryer set to low or cool setting. Hold the dryer at least 12 inches from your head. Wave the dryer slowly back and forth. Don't hold it still.
  • Don't clean inside the ear canal with cotton swabs to remove earwax. This can push dirt and ear wax further into the ear canal. This can cause irritation and infection.

Middle Ear Infections (Otitis Media)

Otitis media is another name for a middle-ear infection. It means an infection behind your eardrum. This kind of ear infection can happen after any condition that keeps fluid from draining from the middle ear. These conditions include allergies, a cold, a sore throat, or a respiratory infection.

More than 80 percent of children have at least one episode of otitis media by the time they are 3 years of age. Middle-ear infections are common in children, but they can also happen in adults. An ear infection in an adult may mean a more serious problem than in a child. So you may need additional tests. If you have an ear infection, you should see your health care provider for treatment.

What are the types of middle-ear infections?

Infections can affect the middle ear in several ways. They are:

  • Acute otitis media: This middle-ear infection occurs suddenly. It causes swelling and redness. Fluid and mucus become trapped inside the ear. You can have a fever and ear pain.
  • Otitis media with effusion: Fluid (effusion) and mucus build up in the middle ear after the infection goes away. You may feel like your middle ear is full. This can continue for months and may affect your hearing.
  • Chronic otitis media with effusion: Fluid (effusion) remains in the middle ear for a long time. Or it builds up again and again, even though there is no infection. This type of middle-ear infection may be hard to treat. It may also affect your hearing.

Who is more likely to get a middle-ear infection?

You are more likely to get an ear infection if you:

  • Smoke or are around someone who smokes
  • Have seasonal or year-round allergy symptoms
  • Have a cold or other upper respiratory infection
  • Family history of ear infections
  • A weak immune system
  • Spends time in a daycare setting

What causes a middle-ear infection?

The middle ear connects to the throat by a canal called the Eustachian tube. This tube helps even out the pressure between the outer ear and the middle ear. A cold or allergy can irritate the tube or cause the area around it to swell. This can keep fluid from draining from the middle ear. The fluid builds up behind the eardrum. Bacteria and viruses can grow in this fluid. The bacteria and viruses cause the middle-ear infection.

What are the symptoms of a middle-ear infection?

Common symptoms of a middle-ear infection in adults are:

  • Pain in 1 or both ears
  • Drainage from the ear
  • Muffled hearing
  • Sore throat

Common symptoms of a middle-ear infection in children are:

  • Unusual irritability
  • Difficulty sleeping or staying asleep
  • Tugging or pulling at one or both ears
  • Fever
  • Fluid draining from ear(s)
  • Loss of balance
  • Hearing difficulties
  • Ear pain

These symptoms may be the same as for other conditions. It’s important to talk with your health care provider if you think you or your child has a middle-ear infection. If you have a high fever, severe pain behind your ear, or paralysis in your face, see your provider as soon as you can.

How is a middle-ear infection diagnosed?

The health care provider will take a medical history and do a physical exam. He or she will look at the outer ear and eardrum with an otoscope. The otoscope is a lighted tool that lets your provider see inside the ear. A pneumatic otoscope blows a puff of air into the ear to check how well your eardrum moves. If you eardrum doesn’t move well, it may mean you have fluid behind it. A hearing test may be done in those with frequent ear infections.

How is a middle-ear infection treated?

A middle-ear infection may be treated with:

  • Antibiotics, taken by mouth or as ear drops
  • Medication for pain
  • Decongestants, antihistamines, or nasal steroids

Your health care provider may also have you try auto-insufflation. This helps adjust the air pressure in your ear. For this, you pinch your nose and gently exhale. This forces air back through the Eustachian tube.

The exact treatment for your ear infection will depend on the type of infection you have. In general, if your symptoms don’t get better in 48 to 72 hours, contact your health care provider.

Middle-ear infections can cause long-term problems if not treated. They can lead to:

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

Ear Tubes

Sometimes fluid stays in the middle ear even after you take antibiotics and the infection goes away. In this case, your health care provider may suggest that a small tube be placed in your ear. The tube is put at the opening of the eardrum. The tube keeps fluid from building up and relieves pressure in the middle ear. It can also help improve hearing. This surgery is called myringotomy. This is commonly required in children but not often done in adults. The tubes usually fall out on their own after 8 months to a year.

Eustachian Tube Dysfunction

The Eustachian tube connects the middle ear to the back of the nose. It serves two main functions. First, it allows pressure to equalize between the middle ear and the outside world. Second, it allows fluid to drain away from the middle ear to prevent infections. In children, the Eustachian tube is shorter and more horizontal than adults leading for more ear infections. This typically normalizes by ages 7-9. However, problems can persists into adulthood. The symptoms of Eustachian tube dysfunction can vary based on the severity but range from persistent ear fullness to recurrent ear infections. This can typically be medically treated, but surgery may be indicated. We are equipped to provide the most up to date diagnostic testing and treatment for Eustachian tube dysfunction.


Cholesteatoma is a benign locally destructive skin cyst that involves the ear. It is typically located in the middle ear and is associated with chronic ear infections. Symptoms can range based on severity, but patients typically have chronic ear drainage and hearing loss. If left untreated, cholesteatoma can lead to serious side effects. Surgery is generally the treatment of choice. We are equipped to provide the most up to date diagnostic testing and treatment for cholesteatoma.