Why adults can get ear infections
Mayo Clinic explains that a middle ear infection, or acute otitis media, is an infection of the air-filled space behind the eardrum. It is caused by bacteria or a virus and often follows another illness such as a cold, flu or allergy, which makes the inside of the nose, throat and ears swollen and congested.
Children get ear infections more often because their Eustachian tubes are narrower and more level, but adults can have them too. NHS 111 Wales notes that ear infections are very common and often get better on their own within 3 days, so you do not always need to see a doctor.
Outer, middle and inner ear problems are different
NHS 111 Wales distinguishes three types:
- Outer ear infection (otitis externa): affects the ear canal, usually in adults aged 45 to 75, and is caused by something irritating the canal, such as eczema, water or ear plugs. See swimmer’s ear and fungal ear infection.
- Middle ear infection (otitis media): affects the space behind the eardrum, connected to the back of the nose by the Eustachian tube, and often follows colds and flu.
- Inner ear infection: affects the inner ear and balance system and can lead to labyrinthitis, with dizziness or vertigo.
The type cannot be reliably identified at home. Dizziness or hearing loss should not be assumed to be an inner ear infection without an examination.
Pain, pressure, discharge and hearing changes
Mayo Clinic lists the common symptoms of ear infections in adults as ear pain or pressure, fluid coming from the ear, which can come from a torn eardrum, and trouble hearing. Symptoms often come on quickly.
NHS 111 Wales adds that ear infections may also cause a high temperature of 38 °C or above, feeling sick, a lack of energy, a feeling of fullness, and, especially with outer ear infections, itching, irritation and scaly skin in and around the ear. Not every earache is an infection: Mayo Clinic notes that many conditions cause similar symptoms. See ear drainage and ear fullness for related symptoms.
Colds, Eustachian tube problems and other contributors
Mayo Clinic explains that the Eustachian tubes run from each middle ear to the back of the throat, behind the nose. They keep air pressure even, bring fresh air to the ear and drain fluid. When they swell and become blocked, for example during a cold or allergy, fluid builds up in the middle ear and can become infected.
Mayo Clinic notes that ear infections are more common in autumn and winter, that seasonal allergies may raise the risk when pollen counts are high and that tobacco smoke and air pollution increase risk. For ongoing blockage, see Eustachian tube dysfunction.
Sudden hearing loss and other urgent warning signs
NHS 111 Wales advises getting urgent advice if you become generally unwell, have a very high temperature or feel hot and shivery, have swelling around the ear, fluid coming from the ear, hearing loss or a change in hearing, or other symptoms such as vomiting, a severe sore throat or dizziness. It also advises getting help promptly if you have a long-term condition such as diabetes or heart, lung, kidney or neurological disease, or a weakened immune system.
Mayo Clinic notes that, rarely, infections that are untreated or do not respond to treatment can spread to the bone behind the ear or to the membranes around the brain. Swelling or redness behind the ear, a severe headache, a stiff neck, confusion or facial weakness need urgent care. Sudden hearing loss should not be put down to an ear infection without assessment; see sudden hearing loss.
Otoscopy and selected hearing assessment
NHS 111 Wales explains that a doctor will usually look into the ear with a small light called an otoscope; some otoscopes blow a small puff of air to check how the eardrum moves, which can show a blockage. Mayo Clinic stresses that many conditions cause symptoms similar to an ear infection, so a proper diagnosis matters.
If hearing remains reduced after the infection, fluid persists or infections keep coming back, a hearing test and an ENT examination can clarify the cause. For adults with recurrent ear infections, persistent fluid or hearing changes, our ENT practice in Bilbao can examine the ear and assess hearing (consultations are in Spanish). Urgent warning signs should go to emergency services first.
Pain relief and antibiotics according to findings
To ease pain, NHS 111 Wales suggests painkillers such as paracetamol (acetaminophen) or ibuprofen, following the label, and a warm or cold cloth on the ear. It advises against decongestants or antihistamines, as there is no evidence they help with ear infections.
For infections inside the ear, NHS 111 Wales explains that antibiotics are not usually offered because these infections often clear up on their own and antibiotics make little difference to symptoms, including pain. They may be prescribed if the infection does not start to improve after 3 days, if fluid is coming from the ear or if there is a higher risk of complications, such as a weakened immune system. For outer ear infections, a pharmacist can recommend acidic ear drops, and a doctor may prescribe antibiotic, steroid or antifungal drops, or tablets for a severe bacterial infection.
Keeping the ear dry and avoiding unsafe products
NHS 111 Wales advises wiping away any discharge with cotton wool, not putting anything inside the ear, such as cotton buds or fingers, and keeping water and shampoo out of the ear. To help prevent outer ear infections, it suggests using ear plugs or a swimming cap when swimming and treating conditions that affect the ears, such as eczema.
Only use ear drops that have been recommended or prescribed for the current problem, and do not use leftover drops or put oils or other products in the ear, especially if there is discharge, which may mean the eardrum is torn. See perforated eardrum. NHS 111 Wales notes that drops may not work if they are not used correctly: lie on your side with the affected ear up and stay lying down for about 5 minutes.
Where the sources differ
Mayo Clinic (April 2025) focuses on middle ear infection and gives most of its detail on children, with a short list of adult symptoms; it also describes fluid that stays in the middle ear after an infection (otitis media with effusion) and infections that do not clear with usual treatment. NHS 111 Wales (December 2024), adapted from the NHS website, covers outer, middle and inner ear infections, self-care and antibiotic use. Its prevention section refers to inner ear infections caused by colds and flu, whereas middle ear infections are the ones that usually follow colds.
On timing, NHS 111 Wales says most infections clear within 3 days and advises seeing a GP if earache does not start to improve after 3 days, while Mayo Clinic advises seeking care for symptoms lasting more than 2 to 3 days. Mayo Clinic notes that most eardrum tears heal within 72 hours, although some need surgical repair. These timeframes do not apply to warning signs, which need care straight away.
In summary
Adults can get outer, middle and inner ear infections, which differ in cause and treatment. Middle ear infections typically cause pain or pressure, reduced hearing and sometimes discharge, often after a cold. Many clear up in about 3 days, and pain relief and a warm or cold cloth can help; antibiotics are used selectively.
See a doctor if earache does not start to improve after 3 days, infections keep recurring or fluid comes from the ear, and seek urgent care for sudden hearing loss, swelling behind the ear, severe headache, facial weakness or feeling very unwell. A timeline noting which ear is affected, when symptoms started, any hearing change, discharge and treatments used is helpful for follow-up.
Frequently asked questions about ear infections in adults
These answers are general information and do not replace an examination or individual medical advice.
Can an adult ear infection improve without antibiotics?
Often, yes. Most ear infections clear within about 3 days, and antibiotics make little difference to symptoms in many middle ear infections. A doctor may prescribe them if there is no improvement, discharge or a higher risk of complications.
How are outer and middle ear problems different?
An outer ear infection affects the ear canal and often causes itching and discharge; it is treated with ear drops. A middle ear infection is behind the eardrum, often follows a cold and causes pain, pressure and reduced hearing.
Can I diagnose an inner ear infection at home?
No. Dizziness and hearing changes have several causes, some urgent, and need examination by a professional.
Can I use leftover ear drops?
No. Use only drops recommended or prescribed for the current problem. Some drops are not suitable if the eardrum is torn, which can happen with discharge.
Why might infections or fluid keep coming back?
Blocked Eustachian tubes, allergies, smoke exposure or fluid that remains after an infection can contribute. Recurrent infections should be assessed by a doctor or ENT specialist.
When does a change in hearing need urgent care?
Sudden hearing loss in one or both ears needs urgent assessment and should not be assumed to be an infection. Hearing loss with dizziness, severe pain or swelling behind the ear also needs prompt care.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.