Ear pain as an adult can feel oddly unsettling. You might assume it is “just pressure” from a cold, or you may worry it is something more serious because ear infections seem like a childhood problem. The reality is that adults get ear infections too, and the right treatment depends on which part of the ear is involved.
Most adult ear infections fall into two buckets: an infection of the ear canal skin (outer ear) or an infection behind the eardrum (middle ear). Those sound similar, but the symptoms, causes, and medications can be very different. Knowing the patterns can help you decide what you can safely try at home and when it is time to be seen.
A quick map of where the infection lives
An “ear infection” is not one diagnosis. It is a location.
- Outer ear infection (otitis externa): The ear canal is inflamed and infected, often after moisture gets trapped or the skin is irritated.
- Middle ear infection (otitis media): Fluid and infection build up behind the eardrum, often after a cold, flu, or allergy flare blocks the eustachian tube.
That location difference is why one person improves quickly with prescription ear drops, while another needs oral antibiotics, evaluation for eardrum issues, or help with nasal and sinus congestion.
Outer vs middle ear infections: what feels different
Pain is common in both types, but the “feel” of the pain and what triggers it can point you in the right direction.
| Feature | Outer ear infection (Otitis externa) | Middle ear infection (Otitis media) |
|---|---|---|
| Where it hurts | Ear canal, near the opening | Deeper, behind the eardrum |
| What makes it worse | Touching the ear, pulling the ear, pressing the tragus | Often worse lying down; not usually worse when touching the outer ear |
| Common extras | Itching, canal swelling, drainage | Pressure, popping, muffled hearing; sometimes fever or sore throat |
| Typical setup | Swimming, trapped water, earbuds/hearing aids, cotton swab irritation | Recent cold or allergies causing eustachian tube blockage |
If you have intense ear pain that spikes when you tug the ear or press the small flap (tragus), that pattern is classic for otitis externa. If it feels like deep pressure with muffled hearing after a respiratory illness, middle ear involvement climbs the list.
Adult ear infection symptoms you should not ignore
Symptoms can start mildly and then ramp up over a day or two. Adults often describe “fullness,” pressure, or hearing changes before they notice drainage.
Many people report a cluster of symptoms rather than one single sign:
- Ear pain or tenderness
- Itching in the ear canal
- A “plugged” or full sensation
- Muffled hearing
- Drainage (clear, cloudy, yellow, or pus-like)
- Fever (more common with acute middle ear infection)
Some symptoms deserve faster medical attention because they can signal a complication or a more invasive infection. Watch for warning signs that change the urgency:
- Severe pain that does not let up: especially if pain medicine is not helping
- Drainage with significant hearing drop: pus, blood, or foul-smelling fluid needs an exam
- Dizziness or true spinning vertigo: can indicate inner-ear involvement
- Facial weakness or numbness: needs emergency evaluation
- Redness or swelling behind the ear: can be a sign of mastoid involvement
- High fever or feeling very ill: can suggest spread beyond a localized infection
If symptoms are not clearly improving after about 48 to 72 hours of careful home care, it is also a good time to be evaluated.
Why adults get ear infections (and what triggers them)
Outer and middle ear infections have different “setups,” even when the symptoms overlap.
Outer ear infections often begin when the ear canal skin barrier is disrupted. Moisture, friction, and minor trauma set the stage. Common bacteria include Pseudomonas aeruginosa and Staphylococcus aureus (often discussed in clinical reviews like StatPearls on otitis externa: https://www.ncbi.nlm.nih.gov/books/NBK556055/).
Middle ear infections often follow congestion that blocks the eustachian tube, which normally ventilates the middle ear. When the tube is swollen from a cold or allergies, fluid can collect behind the eardrum and become infected. Common bacteria include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis (see StatPearls on acute otitis media: https://www.ncbi.nlm.nih.gov/sites/books/NBK470332/). Viruses can trigger the process too, even if antibiotics are not always needed.
Here are the big risk factors clinicians listen for when an adult has ear symptoms:
- Water exposure: swimming, hot tubs, heavy sweating, wet hair left down for hours
- Ear canal irritation: cotton swabs, scratching, frequent earbud use, poorly cleaned hearing aids
- Nasal and sinus inflammation: seasonal allergies, chronic sinus symptoms, recent respiratory infection
- Smoking exposure: active smoking or secondhand smoke can raise middle ear infection risk (Johns Hopkins overview: https://www.hopkinsmedicine.org/health/conditions-and-diseases/otitis-media-middle-ear-infection-in-adults)
- Health conditions: diabetes, immune suppression, eczema or psoriasis affecting the ear canal skin
What you can safely do at home (first day or two)
Home care is mainly about comfort and preventing the situation from getting worse while you decide if you need an exam.
Pain control matters because ear pain can be intense and can disrupt sleep, which slows recovery. Over-the-counter options like acetaminophen or ibuprofen are commonly used, as long as they are safe for you and you follow label dosing.
Keep the ear as calm and dry as possible.
- Pain relief: acetaminophen or ibuprofen (if safe for you), plus a warm compress held to the outer ear
- Dry ear precautions: avoid swimming; tilt the head after showering and gently dry the outer ear only
- Hands off the canal: no cotton swabs, no scratching, no “digging out” wax
- Nasal support (middle ear pressure): saline spray or rinses can help if congestion is part of the picture
If you suspect an outer ear infection, avoid putting random drops into the ear unless a clinician has already confirmed your eardrum is intact. Some products can irritate an already inflamed canal, and certain medications should not be used if there is a perforation.
How clinicians diagnose the problem
An ear exam is not just a quick look. It is a location check.
A clinician typically looks at the ear canal and eardrum with an otoscope, checking for canal swelling, debris, drainage, and eardrum redness or bulging. They may also check nearby lymph nodes, look at the throat and nasal passages, and ask about water exposure, recent colds, allergies, diabetes, immune suppression, and hearing changes.
Sometimes the main issue is fluid behind the eardrum without acute infection (otitis media with effusion). That can cause fullness and muffled hearing with little pain, and it often needs a different plan than bacterial acute otitis media.
Treatment options: what is commonly used and why
Treatment is targeted to the location and severity. A plan that helps one type can be ineffective for the other.
| Situation | Common treatment approach | Why it helps |
|---|---|---|
| Outer ear infection (mild to moderate) | Prescription antibiotic ear drops, sometimes with a steroid | Drops reach the infected canal skin directly and reduce swelling |
| Outer ear infection with heavy swelling/debris | Careful canal cleaning; sometimes an “ear wick” to deliver drops | Swelling can block drops from reaching the infected area |
| Middle ear infection (acute, bacterial suspected) | Oral antibiotics in selected cases; pain control | Medication must reach the middle ear behind the eardrum |
| Middle ear fluid without acute infection | Watchful waiting, treating nasal allergies, follow-up | Fluid can persist after a cold and may clear without antibiotics |
| Fungal outer ear infection | Antifungal drops and canal cleaning | Fungal infections respond poorly to antibacterial drops |
Middle ear infections in adults are more likely than in kids to be linked with an underlying issue (chronic sinus inflammation, smoking exposure, structural blockage, or persistent fluid). That is one reason adults with repeated infections often benefit from follow-up rather than treating each episode in isolation.
When it is time to be seen (urgent care vs emergency care)
If symptoms are mild and you are otherwise healthy, a short trial of home care can be reasonable. If symptoms are severe, fast-moving, or paired with red flags, being seen sooner is safer.
Go in for prompt evaluation if any of the following apply:
- Symptoms are not improving after 48 to 72 hours
- Drainage from the ear, especially pus or blood
- Significant or sudden hearing loss
- Fever with worsening pain
- Diabetes or a weakened immune system
Seek emergency care if you notice signs that point beyond a routine ear infection:
- Facial weakness: drooping, numbness, or trouble closing one eye
- Severe dizziness: true spinning vertigo, inability to walk straight
- Swelling behind the ear: redness, tenderness, ear pushed forward
- Neck stiffness or confusion: severe headache or neurologic symptoms
These align with guidance from major clinical references and patient resources (Mayo Clinic overview: https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616 and Johns Hopkins otitis media page linked earlier).
Prevention that actually helps (without overcleaning)
Preventing adult ear infections is often about protecting the ear canal skin and keeping nasal inflammation under control.
For outer ear infections, moisture and trauma are the repeat offenders. Dry your ears well after swimming or showering, take breaks from earbuds when possible, and skip cotton swabs. Earwax is not “dirt” in most cases; it is protective, and aggressive removal can strip the canal and trigger irritation.
For middle ear infections, the best prevention often sits outside the ear. Managing allergies, treating chronic nasal congestion, and avoiding smoke exposure can lower the chance of eustachian tube blockage and trapped fluid. If you get frequent episodes, it is worth asking a clinician to look for patterns like seasonal triggers, chronic sinus symptoms, or persistent effusion.
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