Ear Infection

Sometimes referred to as: middle ear infection, otitis media, external ear infection, otitis externa, ear ache, ear pain

Interview between:

  • Jamila Schwartz, MD

  • Steven Winiarski, DO

Ear infections are caused by bacteria, viruses, or fungi. They can be divided into two categories: middle ear infection (otitis media) and external ear infection (otitis externa). Middle ear infections involve the space behind the tympanic membrane (eardrum), while external ear infections involve the ear canal leading to the tympanic membrane.

Cases Per Year (US)

2.4 million cases of otitis externa. 5 million cases of otitis media in children.

General Frequency

1 in 10 people will suffer from otitis externa in their lifetime. The incidence of otitis media in adults is .25%. 60% of children are likely to have at least 1 episode of otitis media before the age of 4.


Low. In children, 80% of otitis media resolves without treatment. 2 in 10,000 cases will progress to local bone infection. Complications from otitis externa are also rare, but include abscess formation and the infection spreading to tissue and bone.



What causes ear infections?

Bacteria cause the vast majority of ear infections. But they are also, less commonly, caused by viruses and fungi.

In the middle ear, inflammation or blockage of the eustachian tube, which normally equalizes pressure, can lead to an accumulation of fluid that creates a favorable environment for bacterial growth. This is often due to upper respiratory infections and seasonal allergies, but can also be the result of a physical blockage from an external mass.

External ear infections, on the other hand, stem from a microscopic trauma to the ear canal tissue combined with either a favorable environment for bacterial growth or direct exposure to bacteria. The micro-trauma can result from direct injury by foreign objects—such as a Q-tip or fingernail-excessive exposure to water, or skin conditions like eczema.

What are common symptoms?

Ear pain is the most common symptom of both otitis media and otitis externa. Other symptoms include decreased hearing and a watery or yellow drainage.

How are ear infections diagnosed?

A middle ear infection is diagnosed by inspecting the tympanic membrane with an otoscope. Typical findings include a bulging tympanic membrane—red or opacified—and either fluid behind the eardrum or decreased tympanic mobility measured by pneumoscopy. A perforated tympanic membrane with or without purulent (pus-filled) fluid drainage is also an indicator.

Diagnosing an external ear infection relies on a history of rapid onset of symptoms along with pain, swelling, or redness of the ear canal. This may or may not include drainage, hearing loss, and swollen lymph nodes.

What are other common causes of ear symptoms that are not an ear infection?

Shingles (herpes zoster) can cause ear pain for days prior to the appearance of the typical rash around the ear.

Conditions involving the nasopharynx (pharyngitis, eustachian tube dysfunction, etc.) can manifest as ear pain in the absence of other signs of ear infection. Recurrent or chronic ear pain with milder signs of infection should be promptly investigated for fungal causes.


Medical Treatment


Lifestyle Considerations



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Jamila Schwartz, MD and Steven Winiarski, DO are both members of the Galileo Clinical Team. Connect with one of our physicians about Ear Infection or any of the many other conditions we treat.

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