What is an Ear Infection?
Bacteria or viruses can cause an ear infection that affects the outer or middle part of your ear. There are two main types of infection based on where it occurs. Outer ear infections affecting the ear canal are called acute otitis externa or swimmer’s ear (x). Acute otitis media, or infection of the middle ear, affects the space behind your eardrum that transmits sound for hearing (x, x).
Ear Infection Symptoms
Signs of an outer ear infection include discomfort and itching in the canal. Because it affects the outer structures, the redness is more visible. The pain is usually worse if you push on the bump in front of your ear, known as your tragus, or pull on your outer ear (x). Middle ear infection symptoms also include ear pain, but the visible signs are not as noticeable. Because the infection is behind the eardrum, the canal or outer ear usually appears normal.
Drainage of Fluids
As the infection progresses, some people may develop fluid draining from their ear. This fluid may be clear and odorless in mild cases, but pus may indicate more severe infection (x). Both outer and middle ear infections may produce fluid, otherwise known as an effusion, which may feel like fullness in the affected ear (x).
Loss of Hearing
The swelling and fluid drainage associated with ear infections may block effective sound transmission in your ear. That’s why some people experience decreased or muffled hearing when they have an ear infection (x). Effusions in the middle ear, or fluid buildup, can also produce muffled hearing. Chronic effusions are fluid buildups that last a long time, which can cause problems with hearing long term (x).
Ear Infection Symptoms in Children
In kids, symptoms of an ear infection may not be as obvious. Younger children and babies have trouble communicating that something is wrong. Some clues that you can look out for include frequent tugging or pulling on an ear. Pain is usually worse when kids lay down for bed, so some will have more trouble sleeping (x). Crying more often than usual, acting more irritable and loss of appetite may also be signs of an ear infection in a small child.
Other Characteristics of Ear Infections
People with ear infections may develop fever, a defensive immune reaction to fight off bacteria and viruses. In rare cases, some may also experience dizziness or vertigo because structures in our ear help us with balance. Other signs and symptoms of an ear infection may include headache, swollen lymph nodes and face or neck pain (x, x).
What Causes Ear Infections?
People with allergies are more prone to get middle ear infections (x). Allergies are your immune cells overreacting and causing swelling and inflammation. How does this happen? Well, it starts with the eustachian tubes — thin tunnels that connect from the middle ear to the back of the throat. These tubes allow both mucus and swelling from allergies to spread to the middle ear, creating a favorable place for bacteria or viruses to grow (x). Allergy-induced inflammation may also be a risk factor for outer ear infections as well (x). In these cases, sensitivities to items like hair products or earrings could cause skin reactions promoting infection (x).
Like allergies, sinus infections can increase inflammation of the nasal passages and associated ear structures. This inflammation can again produce favorable conditions for microbes to grow. Especially in kids, a recent cold or flu affecting the upper respiratory tract increases the risk of developing ear infection (x). That’s because the swelling and inflammation around the eustachian tubes can make drainage from the middle ear less effective. Older patients suffering from chronic sinus infections and nasal polyps are also at higher risk for developing ear infections (x). The shape and elasticity of the eustachian tube, based on genetic factors or aging, can be a risk factor as well. All of these factors usually involve poor drainage that results in fluid getting stuck in the middle ear, promoting infections (x).
Tobacco smoke can irritate your respiratory tract and is a risk factor for ear infections (x). You don’t have to be a smoker yourself to be at risk (x). Secondhand smoke can irritate and can promote infection too. Kids and babies of parents who smoke are at a higher risk of developing ear infection (x). A Norwegian study found that babies of mothers who smoked cigarettes during pregnancy were more susceptible to chronic ear infections in infancy or childhood (x). A review performed by Chinese researchers also noted an increased risk for people exposed to second-hand smoke (x).
Infected or Swollen Adenoids
Poor fluid drainage from your middle ear harbors bacteria and promotes infections. Adenoids are a pair of small tissue pads that are located in the upper respiratory tract and help fight off infection. They are filled with immune cells and get inflamed when active. These structures sit near the eustachian tubes and can block proper drainage when swollen. In kids, the adenoids are exceptionally large and play a more prominent role in causing ear infections (x). Adenoids may also harbor infectious microbes that can cause an infection. A 2017 study found that many of the same bacteria found in adenoid tissue were also isolated from the middle ear of children, especially kids who had ear infections with effusion (x).
Other Causes of Ear Infections
Other lifestyle factors may influence your risk of getting an ear infection. Younger kids tend to get more of them because of the specific anatomy of the eustachian tubes at that age. Kids at daycare settings also have a higher risk since they are more exposed to germs in this setting (x). Children who are unvaccinated for pneumonia, meningitis and influenza may also be at higher risk as well (x). Babies who are bottle-fed instead of breastfed have a higher rate of ear infection (x). Swimming also increases the risk, especially if in un-chlorinated waters like a lake or a poorly maintained pool. Aggressive cleaning or hearing aids are also risk factors for an outer ear infection (x). The CDC recommends that you avoid putting cotton swabs or other foreign objects that may cut or bruise your ear canal, directly into the ear (x).
Supplements for Ear Infections
Treating an ear infection usually doesn’t require antibiotics because your immune system can usually handle it on its own. Exceptions may include severe cases, recurrent infections or swimmer’s ear for which doctors generally prescribe antibiotic drops (x). The pain associated with a mild ear infection could be treated with natural or prescription ear drops. However, ear infections could become dangerous, especially if they are due to severe disease that is left untreated. This severe disease may lead to ruptured eardrums and/or a spread of the infection. Permanent damage to middle ear structures can lead to hearing loss. Surgical repair may be necessary if there is a rupture of the eardrum (x). Contact your doctor if symptoms last more than three days, if there is pus coming from the ear, or if you have a high fever over 102.2 degrees Fahrenheit (39 degrees Celsius) (x).
There are many claims for garlic as an alternative remedy for an ear infection, but the scientific evidence is limited. One pediatric study from 2001 found that herbal preparations that included garlic (Allium sativum) extract, suspended in olive oil mixed with other extracts, was just as effective as prescription eardrops in reducing pain related to ear infections (x). Another similar study appeared in 2003 suggesting herbal ear drops containing garlic could reduce ear pain as well (x). One review reported laboratory evidence supporting the antibacterial and antifungal activity of garlic oil in vitro. However, no studies have confirmed its antimicrobial action in human patients with an active ear infection (x).
Though there aren’t any official recommendations for using garlic oil for infections, there are studies that were done on the use of ear drops containing garlic oil (x, x). Neither study reported any significant side effects, but you should always consult with your doctor before starting any alternative remedy. Avoid using any ear drops if the eardrum is ruptured, or if a doctor has placed an ear tube to drain an effusion (x).
Xylitol is a natural ingredient found in fruits and vegetables and is a molecule composed of sugar and alcohol (x). One review in 2014 reported xylitol as a natural agent that may prevent ear infections in susceptible children. Older studies found the highest efficacy in chewing gum and lozenges compared to syrup. However, children under two should not use these treatments due to choking hazards (x). A 2016 Cochrane review noted some evidence supporting xylitol as a preventative treatment for healthy children going to daycare (x), but found it was not effective in children prone to infection. Another recent study by the National Institute of Health also found that xylitol solution was not effective in preventing ear infection in children prone to getting them (x).
To protect against ear infection in children, it is best to take 8.4 to 10 grams for chewing gum, syrup or lozenges five times a day with meals. Though there were no major side effects reported in these studies, one could experience stomachache, bloating or diarrhea when consuming any sugar alcohol like xylitol (x).
Studies have reported a relationship between vitamin D deficiency and increased recurrent ear infections in children. Some of these studies also observed reduced rates during a 1-year follow up period when children had vitamin D levels replenished through supplementation. Researchers believe that vitamin D could play a significant protective role in preventing ear infection (x). However, more clinical trials are necessary to support any recommendations.
Vitamin D supplements are available both over-the-counter or as a prescription from your doctor. However, if you take too much vitamin D, it can become toxic. Symptoms of toxicity include appetite loss, weight loss, excess urination and heart palpitations. Long-term effects of toxicity can damage your heart, blood vessels and kidneys. Also, if you are taking steroid medications or weight loss drugs, you should avoid taking vitamin D supplementation due to potential drug-drug interactions (x). Therefore, if you plan to supplement your diet with vitamin D, consult with your physician before taking any amount of the supplement.
The Bottom Line
Ear infections are more common in children but can affect adults too. These infections, caused by bacteria or viruses, usually go away on their own. However, permanent hearing loss can come as a result. And though natural remedies can be a great way to promote your health, always talk with your doctor before starting a home treatment.
By: Lulu Wong