WHEN SHOULD I WORRY ABOUT...

Earaches in Adults: What You Need to Know

Aug. 10, 2021 - Eden McCleskey

Been a while since you woke up with a sharp, stabbing earache? Such a distant memory you don't even know where to find a heating pad like the one your mom used to carefully apply to the side of your face?

Consider yourself lucky — but not necessarily off the hook. Although ear infections are more common among children, some 20% occur in adults. Bad news for those of us who thought we had outgrown that phase for good. But the good news is, for the most part, there are easy ways to fix the problem, and even easier ways to avoid the common mistakes that can land even the most responsible adults in the reclining chair of an ear, nose and throat doctor (ENT).

Luckily, Dr. Brian Wang, an ENT doctor at Houston Methodist, is here to answer all of our burning questions about the types of ear problems that most frequently occur in adults.

What is the most frequent type of ear infection in adults?

Dr. Wang: An outer ear infection, or otitis externa, is the type we most frequently encounter in adults. These can strike anyone at any age, with or without a history of ear infections. Outer ear infections are also known as swimmer's ear, because they are typically caused by the introduction of moisture from outside the body. The ear canal is a warm, moist area of the body, the perfect breeding ground for bacterial or fungal growth and an easy entry point for moisture to enter. Adults who are more predisposed to getting otitis externa include those with eczema of the ear canal and those who frequently insert cotton swabs into their ear canal.

How do cotton swabs cause outer ear infections?

Dr. Wang: Earwax is a natural way for your body to trap and slow the growth of bacteria that may have entered your ear. When you apply cotton swabs, you often wind up pushing earwax further into the ear canal. This impacted wax can then trap water or moisture deep in the canal, setting you up for an infection.

So … we should NOT insert cotton swabs into our ears to try to clean them or remove earwax, right?

Dr. Wang: Correct. Use of Q-Tips can cause not only outer ear infections, but also trauma of the ear canal or eardrum, which can affect hearing and cause other types of infection and ear pain. Also, part of the swab can break off, leaving a foreign body in your ear that needs to be removed. It's a common reason for ER visits, actually. If you feel you have a buildup of ear wax, I recommend applying a tissue or soft thin cloth to your finger and wiping gently around the entrance to the ear. There are also over-the-counter ear wax removal kits from Debrox® that are safe to use, when used as directed.

Can you get an outer ear infection from sweating a lot when you work out?

Dr. Wang: It's not common, but yes. It's called swimmer's ear because that is what usually causes it. But moisture can also be introduced into the ear from showering, taking a bath, rain or sweat dripping into your ear — even high humidity. Outer ear infections are mostly caused by bacteria, but they can also be caused by fungus, such as the fungus that causes athlete's foot.

What do you suggest for people who feel like there might be moisture in their ears?

Dr. Wang: You can usually feel it if there's some water in your ear, right? If you notice that, turn your head to the side and try to shake the water out or let it drain out. You can also place a tissue paper or thin dry cloth around your finger and wipe outside the opening of your ear with your head turned sideways. If you still feel it, or have a history of getting a lot of outer ear infections, use drops to dry out your ears. You can buy Swim-EAR® or other brands over the counter, or you can look up how to make your own by mixing together rubbing alcohol and vinegar. A cool or warm hair dryer may also be effective.

How are outer ear infections treated?

Dr. Wang: Most ENT doctors and primary care physicians will prescribe antibiotic ear drops only. Typically, oral antibiotics are not necessary, and we like to avoid overprescribing them so they continue to work when we actually need them. Occasionally, the opening of the ear may be too inflamed or sticky to get the drops in, so we have to stick a little wick in there to get the drops where they need to go. The provider may prescribe oral antibiotics if the outer ear infection is really severe.

What other types of ear infections affect adults?

Dr. Wang: A middle ear infection, or otitis media, is most frequently associated with children, but adults get them as well. This type of ear infection happens when viruses or bacteria get into the middle ear — the space behind the eardrum. The middle ear fills with pus or infected fluid. The pus pushes on the eardrum, which can be very painful. Middle ear infections are caused by swelling in one or both of the Eustachian tubes. The Eustachian tubes connect the middle ear to the back of the throat and act as release valves to equalize pressure within the middle ear. When that process is interfered with, that's when infections can develop.

What's the difference between the middle ear infections we get as children versus the middle ear infections we get as adults?

Dr. Wang: The underlying causes are usually different. They are more frequent in children because their shorter, more horizontal Eustachian tubes are more likely to get blocked. Also, their adenoids are larger compared to the rest of the throat and can interfere with the opening of the Eustachian tubes. And finally, children's immune systems are immature and colds and viruses are often passed around day care and school.

So what causes middle ear infections as adults?

Dr. Wang: In adults, they are usually associated with inflammation in the nasal cavity or the throat, such as a sinus infection, strep throat, cold or flu — or if the patient has acid reflux, bad seasonal allergies, is a smoker or is exposed to second-hand smoke. The nasopharyngeal inflammation leads to Eustachian tube dysfunction, which then leads to fluid developing in the middle ear that then becomes infected. Sometimes patients who had middle ear infections a lot as kids continue to get them frequently as adults. Something about the anatomy or physiology of their tubes was never really resolved.

How are middle ear infections treated?

Dr. Wang: Frontline treatment for middle ear infections is a course of oral antibiotics. Sometimes steroids can be added if the pain is severe, which doesn't help resolve the infection any faster but can reduce the inflammation and pressure causing the pain. If you've been on standard treatments for several days but your ear still aches or feels full, you should be referred to an ENT, who may recommend different medications or elect to lance the eardrum to remove the fluid. If you keep getting middle ear infections, you may have to have ear tubes placed in your ears, just like we do with children.

Are there any differences in getting ear tubes as an adult versus as a child? Do you still have to avoid swimming?

Dr. Wang: They function pretty much the same for kids as adults. You still have to have relative water precautions. You can swim but it may be safest to use ear plugs or a swim band to keep water out. The main difference is adults typically do fine with ear tube placement in the office. There's no need for an OR or general anesthesia like there traditionally has been for kids. Actually, there's a new procedure for placing ear tubes in kids that allows us to do it super quickly with local anesthesia only. So now we can do that in clinic as well.

Any other recent innovations in the treatment of ear infections?

Dr. Wang: There's a procedure I've been doing for a few years called Eustachian tube dilation. Using endoscopic guidance through the nose, you insert a balloon in the Eustachian tube, blow it up and leave it there for up to two minutes. This can address the Eustachian tube dysfunction that leads to middle ear infections. I've found it works in about 50% of patients, so it doesn't work for everyone. But it's so noninvasive, it's a good place to start with certain patients who are good candidates for it. There's also a new drug that is almost like a gel that you can squirt into the ear canal. It slowly dissolves and may be easier to get into those really clogged areas than traditional drops.

Are there other types of ear infections that can affect adults?

Dr. Wang: There is something called an inner ear infection. Inner ear infections are pretty different from outer and middle ear infections, and much rarer overall. We see them primarily in adults. Inner ear infections typically present with hearing loss, vertigo, dizziness, nausea and vomiting. If you have these symptoms, you should rest, avoid driving, sudden movements and alcohol. Inner ear infections will usually clear up in several days on their own, but if symptoms don't go away, you should call your primary care provider or ENT doctor. Note: If you have sudden hearing loss in one ear, get in to see your doctor immediately or call 911, because tests need to be performed immediately.

Any other words of advice for adults regarding ear infections?

Dr. Wang: Do not stick anything in your ears! Also, if you have diabetes, be very careful with ear infections. They might be much more persistent, painful and treatment resistant. If this happens to you, really prioritize getting your blood sugar under control, because that can greatly affect your body's ability to shake the infection.

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