What is ear infection?
There are two main kinds of ear infection in adults. Otitis media is infection or inflammation of the middle ear, typically following a cold when the eustachian tube blocks and fluid builds up behind the eardrum. Otitis externa — "swimmer's ear" — is infection of the outer ear canal, usually from trapped moisture, irritation from earbuds, or excess Q-tip use.
Middle ear infections are more common in young children because of their anatomy. In adults, they're less common but happen — usually as a complication of a cold or sinus infection. Outer ear infections are common at any age, especially after swimming or persistent water exposure.
Distinguishing them matters because middle ear infections may need oral antibiotics, while outer ear infections respond to ear drops and trying to keep the ear dry.
Do I have ear infection? Common signs
If most of these describe what you're experiencing, telehealth is a reasonable next step:
What causes it
Middle ear infections are most often bacterial (Streptococcus pneumoniae, Haemophilus influenzae) or viral and typically follow a cold or sinus infection. Outer ear infections are usually bacterial (Pseudomonas aeruginosa, Staphylococcus aureus) and start when the protective wax barrier is disrupted by moisture, scratching with Q-tips, or skin conditions.
Is it contagious?
Ear infections themselves are not contagious. But the cold or sinus infection that often precedes a middle ear infection is contagious. Outer ear infections are caused by your own skin bacteria multiplying — also not transmissible.
Adult ear pain after a cold is usually middle ear pressure — and an antibiotic isn't always the answer.
Can it be treated online?
For adults, telehealth can usually distinguish outer from middle ear infection from your symptoms — pain location, timing, recent water exposure, hearing changes, drainage. Outer ear infections (swimmer's ear) are particularly telehealth-friendly. Middle ear infections in adults can also be reasonably treated empirically based on classic symptoms.
For children under 12, an in-person look with an otoscope at the eardrum is needed for confident diagnosis — kids should be seen in clinic.
How ear infection is treated
Outer ear (otitis externa): prescription antibiotic ear drops, often combined with a steroid — products like ciprofloxacin-dexamethasone (Ciprodex) or ofloxacin. Keep ear dry. Pain relief with acetaminophen or ibuprofen.
Middle ear (otitis media) in adults: many mild cases improve without antibiotics. If symptoms are moderate-severe or not improving after 48 hours, oral amoxicillin or amoxicillin-clavulanate for 5–10 days. Pain control is important.
Self-care while you wait
- Take pain relievers as needed (acetaminophen or ibuprofen)
- Apply a warm compress to the ear
- Keep ear dry — no swimming, shower with a cotton ball coated in petroleum jelly
- Avoid putting anything in the ear canal (no Q-tips, no hairpins)
- Sleep with the affected ear up
- Decongestants may help middle ear pressure from a cold
- Don't fly if you can avoid it — pressure changes worsen the pain
How long does it last?
Outer ear infections typically improve within 48–72 hours of starting drops and clear within 7–10 days. Middle ear infections in adults usually improve within 2–3 days on antibiotics. Fluid behind the eardrum may take weeks to clear after the infection resolves.
Frequently asked questions
Can adults get ear infections?
Yes — less commonly than kids, but adults do get both middle ear and outer ear infections. Outer ear ("swimmer's ear") is actually more common in adults than middle ear infections.
Do I need antibiotics for an ear infection?
Outer ear infections do need prescription antibiotic drops. For mild adult middle ear infections, watchful waiting with pain control is often appropriate; moderate-severe cases need oral antibiotics.
Why does my ear hurt when I fly with a cold?
A cold blocks the eustachian tube, so pressure can't equalize between the middle ear and the air pressure outside. Cabin pressure changes during ascent and descent can cause significant pain and even rupture the eardrum.
How do I prevent swimmer's ear?
Dry your ears thoroughly after swimming — tilt your head to drain each ear, use a hair dryer on low. Don't use Q-tips (they push wax in and irritate the canal). For frequent swimmers, ear drops with a mix of rubbing alcohol and white vinegar after swimming can help prevent recurrence.
What if my eardrum ruptures?
You may notice sudden pain relief, drainage, and reduced hearing. Most ruptured eardrums heal on their own within 2 months. Keep the ear dry during healing. You'll usually need antibiotic drops, and a follow-up with ENT.
