Otitis media in adults

Overview

Otitis media is an infection or inflammation in the middle ear, the air-filled space behind the eardrum. It often causes ear pain and sometimes temporary hearing loss. In adults, it often follows a cold or allergies.

Otitis media is less common in adults than in children, but it still occurs, especially in adults with certain risk factors.

Adults of any age can develop otitis media, but it is more common in those who smoke, have allergies, or have a weakened immune system.

Symptoms

Common symptoms

• Ear pain (sometimes severe)
• Feeling of fullness or pressure inside the ear
• Temporary hearing loss or muffled sounds
• Fluid draining from the ear (clear, yellow, or bloody)
• Fever (especially if the infection is bacterial)

Symptoms in children

• In children, symptoms may include ear pulling or tugging, irritability, trouble sleeping, or crying more than usual.

Symptoms in older adults

• In older adults, symptoms may be less obvious, such as mild hearing loss, balance problems, confusion, or a general feeling of being unwell.

Causes

Main causes

• Viral infection, such as a common cold or flu, which causes swelling in the eustachian tube
• Bacterial infection, often following a viral illness
• Blockage of the eustachian tube due to allergies, sinus infection, or enlarged adenoids

Risk factors

• Smoking or exposure to second-hand smoke
• Seasonal allergies or year-round allergies (like dust mites)
• Weak immune system (due to medications, illness, or stress)
• Frequent colds or sinus infections
• Rapid changes in air pressure (for example, flying or scuba diving)
• Having a cleft palate or other structural problem

When to see a doctor

See a doctor urgently if:

• If you have severe ear pain, a high fever, or notice swelling behind your ear
• If you have sudden hearing loss or facial weakness
• If you have a discharge of pus or blood from your ear

Book a routine appointment if:

• If ear pain lasts longer than 2–3 days without improving
• If you have mild hearing loss that does not clear up after the pain goes away
• If you have recurrent ear infections (more than 3 in 6 months)

Diagnosis

Your doctor will examine your ear using a special tool called an otoscope, which has a light and a magnifying lens to look at your eardrum. They will check for redness, bulging, or fluid behind the eardrum.

Tests that may be done

• Tympanometry – a quick test that measures how your eardrum moves in response to a small puff of air. This can show if there is fluid in the middle ear.
• Hearing test (audiometry) – if you have hearing loss that does not go away after the infection clears.

What to expect at your appointment

The examination is quick and not painful. Your doctor may gently tug on your ear to see if it hurts. If needed, they will also check your throat and sinuses for other causes.

Treatment

Treatment depends on whether the infection is viral or bacterial, and how severe it is. Many cases improve with self-care alone. If bacteria are suspected, your doctor may prescribe antibiotics. They will also treat any underlying causes like allergies.

Self-care at home

• Rest and drink plenty of fluids to help your body fight the infection.
• Take over-the-counter pain relievers such as paracetamol or ibuprofen to reduce pain and fever. Always follow the dose instructions on the package.
• Place a warm, dry cloth over your ear for 10–15 minutes several times a day to ease discomfort.
• Avoid getting water in your ear while bathing or swimming until the infection resolves.
• Do not insert anything into your ear canal, including cotton swabs.

Medical treatments

If your doctor determines the infection is bacterial, they will usually prescribe an antibiotic course for 7–10 days. For viral infections, antibiotics are not effective, and the focus is on managing symptoms. For people with chronic or recurrent infections, a long-term low-dose antibiotic might be considered. Decongestants or antihistamines can help if allergies or sinus congestion are contributing.

When is surgery considered?

In rare cases of chronic otitis media with persistent fluid or repeated infections that do not respond to treatment, a small operation called a myringotomy may be performed. A tiny tube is placed in the eardrum to drain fluid and equalize pressure. This is more common in children but can also be done in adults.

Living with this condition

Most people recover fully from otitis media within 1–2 weeks. Hearing usually returns to normal once the infection clears, though it may take a little longer.

Lifestyle tips

• Avoid smoking or exposure to second-hand smoke, as it can worsen symptoms and increase the risk of recurrent infections.
• Manage allergies with the help of your doctor (using antihistamine or allergy shots if needed).
• Stay up to date with recommended vaccines, such as the flu vaccine and the pneumococcal vaccine, to lower your chances of getting infections that can lead to otitis media.

Diet and exercise

There is no special diet for otitis media, but eating a balanced diet rich in fruits, vegetables, and whole grains can support your immune system. Gentle exercise is safe as long as you feel up to it, but avoid activities that involve sudden pressure changes (like scuba diving) until your ear has fully healed.

Mental health and emotional wellbeing

Ear pain can be distressing and may temporarily affect your mood or sleep. If hearing loss persists, it can lead to feelings of isolation or frustration. These feelings usually go away as the ear heals, but if they last, speak with your doctor.

Prevention

You cannot always prevent otitis media, but you can reduce your risk by avoiding smoking, managing allergies well, and treating colds and sinus infections promptly.

Vaccines

Getting the annual flu vaccine and the pneumococcal vaccine (as recommended by your doctor) can lower your chances of developing ear infections that are caused by influenza or certain bacteria.

Screening programmes

There is no routine screening for otitis media in adults. If you have recurrent infections, your doctor may investigate underlying causes such as allergies or anatomical issues.

Complications

If left untreated

• Chronic infection that persists or returns frequently
• Long-term hearing loss, especially if the eardrum or middle ear bones are damaged
• Spread of infection to the mastoid bone (mastoiditis), which may cause swelling, pain, and fever
• A hole in the eardrum (tympanic membrane perforation), which usually heals on its own but can sometimes require repair

Long-term outlook

With proper care, most adults with otitis media recover completely without lasting problems. Even when complications occur, they are usually treatable. The outlook is very good, especially if you see a doctor when needed and follow their advice.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.