How To Prevent Ear Infections In Adults

Ear infections are common in the population and can affect any part of the ear, from the pinna (the ear lobe) to the inner ear, which houses the organs responsible for hearing and balance. Ear infections frequently lead to visits to the A&E (accidents & emergency), and if undertreated or untreated ear infections can lead to devastating consequences in the short and long term. But is there any way to prevent these infections from occurring in the first place?

There are different types of ear infections, and it is not always possible to prevent some of them. However, infections of the outer ear (otitis externa) are especially influenced by lifestyle factors, and therefore, there are numerous steps one can take to prevent outer ear infections in adults. Some steps can also be taken to reduce middle ear infections (otitis media), though these are more applicable for children than adults. 

To get a better idea of how to prevent ear infections in adults, one must understand why some measures are effective in disease control and to do that, we must dig a bit deeper into the ear. 

Understanding ear infection in adults

You can think of the ear in four parts: The pinna (ear lobe), the outer ear canal, the middle ear, and the inner ear. The outer ear canal is separated from the middle ear by the eardrum, also called the tympanic membrane. The inner ear is a bit more complex; it houses two very important sensory organs - the labyrinth (or internal ear) and the organ of Corti. The labyrinth is responsible for maintaining balance and the organ of Corti, which is responsible for hearing, is embedded within the cochlea, which is the snail-shaped structure inside your inner ear, as you may remember from high school. 

Each of these parts can have separate infections. An infection of the pinna is called  perichondritis. This results in your ear lobe swelling up, becoming red and acutely painful. This condition is most commonly associated with ear piercings that go through the cartilage (such as tragus or helix piercings) and trauma, although immunodeficiency, such as seen in diabetes mellitus, is another important predisposing cause. Though this condition does not affect hearing, it is very persistent and hard to treat without administering antibiotics. If untreated, it can lead to severe deformation of the pinna, although it is fortunately highly responsive to antibiotics.1

Infection of the outer ear canal is called otitis externa ( also called swimmer's ear) and is highly responsive to preventive measures. It is associated with severe pain in the ear that is especially sensitive to touching and tugging the pinna, with ear discharge and if the inflammation is severe enough, with hearing loss due to the outer ear canal developing oedema and constricting the passage.2 The skin overlying the outer ear canal is highly effective in preventing infection, but several factors can make this skin more sensitive. Excessive moisture, for those who frequent swimming pools, will disrupt the functioning of this skin and make it easier for bacteria to cause infection. This is why in people who are susceptible to otitis externa, wearing earplugs while swimming is a very effective way to prevent ear infections. Additionally, foreign bodies in the outer ear can also act as seeds of bacterial colonisation, leading to otitis externa, and it is not uncommon for q-tips to get stuck in the ear when used for ear cleaning. Therefore, avoiding the use of q-tips is another excellent way of preventing ear infections.3 

Infection of the middle ear is called otitis media and is seen much more frequently in children and as such will be talked about briefly. One of the most important mechanisms of the development of otitis media is a dysfunction of the eustachian tube, which connects your middle ear to your nasopharynx (the backside of your nose), providing ventilation and pressure control to the middle ear.4,5 In children, this tube is less developed than in adults, leading to improper ventilation and susceptibility to acute otitis media. Since the opening of the eustachian tube is in the nasopharynx, conditions that affect this area lead to increased susceptibility to acute otitis media, such as upper respiratory infections, sinus infections, the presence of adenoids or allergies. Even after the infection heals, there is often leftover fluid remaining in the middle ear, and if the eustachian tube dysfunction is severe, this fluid may never be able to drain on its own, leading to a condition called otitis media with effusion. This can cause hearing loss in children and is treated with tympanostomy tubes (a.k.a. ear tubes, ventilation tubes, or grommets).4,5 Importantly, in adults, nasopharynx cancer can block the eustachian tube, leading to repeated bouts of otitis media and otitis media with effusion.6 Tympanostomy tubes facilitate the ventilation of the middle ear when the eustachian tube is blocked, which is highly effective in preventing middle ear infections, although this is more relevant for children.

Chronic otitis media is a chronic ear infection where repeated bouts of acute otitis media eventually damage and perforate the eardrum and lead to chronic infection in the middle ear. It can be associated with extensive destruction in the middle ear and almost always requires surgery to treat. The best way to prevent the development of this pesky condition is to always treat acute otitis media.7 

An inner ear infection is called labyrinthitis and is beyond the scope of this article. Just know that it causes severe vertigo and hearing loss on one side, and admission to the hospital is usually required.8

Common causes 

Perichondritis and otitis externa are almost always caused by bacteria, and fungal otitis externa is caused by fungi. Piercings and trauma are the main risk factors for perichondritis, and swimming and foreign bodies are the main risk factors for otitis externa.

Acute otitis media is often caused by viruses and sometimes complicated by bacterial infection. Chronic otitis media is always associated with bacteria, while labyrinthitis can be caused by either viruses or bacteria. Common predisposing factors to acute otitis media are eustachian tube dysfunction as discussed above, upper respiratory infections, allergies, and exposure to cigarette smoke. By far, the most important risk factor for chronic otitis media is untreated acute otitis media. Though treatment can consist of watchful waiting alone under medical supervision, it should nevertheless always be evaluated by a professional.


Signs of symptoms of ear infection vary depending on the site and they have been discussed extensively above. Ear infection symptoms are usually clearly defined.


Your doctor will use an otoscope to see the inside of your ear and check for inflammation when they suspect acute otitis media or external. They may suggest certain tests to determine the severity of the infection, like a CT. Perichondritis is more easily examined and diagnosed as the infection is on the outside of the ear.

How to prevent ear infections in adults

Though aforementioned, here are some guidelines on how to prevent ear infections in adults:

  • If you are prone to develop otitis externa or have developed recurrent ear infections, always make sure to wear earplugs when going swimming. This will prevent the build-up of moisture in your ear canal and make it harder for bacteria to cause infection.9
  • Do not use q-tips for ear cleaning. Q-tips will not only damage the skin of your ear canal but can compress any ear wax you may have, causing temporary hearing loss and the cotton tips can get dislodged and stuck in your ear canal, making an excellent seeding ground for bacteria. All these factors will make otitis externa more likely.3
  • If you are immunocompromised (diabetes mellitus, HIV, cancer etc), make sure that your conditions are well controlled. Immunodeficiency is one of the prime factors for fungal infection of the ear and is a risk factor for the development of malignant otitis externa, which is a medical and surgical emergency and can require not just ear surgery but also extensive neck surgery to treat.
  • If you have severe ear pain that has newly developed, make sure to visit a healthcare professional. It might be acute otitis media, and acute otitis media, if untreated, has a chance to develop into chronic otitis media, which will require surgery to treat.
  • If you have a perforation in your eardrum (as a result of trauma, diving or acute otitis media), avoid swimming and always use ear protection while taking a shower. Contact of water with the middle ear is one of the key reasons for developing an acute flare-up of chronic otitis media, and each flare is associated with a significant worsening of the chronic condition.3

How to treat ear infections in adults 

Treatment of ear infections should always be initiated and led by a healthcare professional.


Home remedies are unadvisable. But as a brief rundown of each type of ear infection, here is some information:

  • Perichondritis is treated with antibiotics and topical therapy (such as a diluted solution of boric acid applied to the pinna and dressed with compression). If significant swelling, a haematoma, or an abscess is present, incision and drainage will be performed with or without hospital admission. 
  • Otitis externa is usually treated with ear drops. These will usually be a combination of corticosteroids and antibiotic ear drops, though for fungal otitis externa antifungal droplets are used instead.
  • Acute otitis media, especially in children, is often treated with watchful waiting, as most cases resolve spontaneously. If it fails to resolve on its own or the infection is severe, antibiotics are given to prevent the development of complications, among which is the development of eardrum perforation and chronic otitis media.
  • Chronic otitis media is treated with surgery. Flares can be treated with ear droplets, but the definitive treatment is through surgical intervention.
  • Labyrinthitis requires admission and intense treatment with corticosteroids and potentially antibiotics to prevent permanent hearing loss. 

Natural ways

Natural home remedies are unadvisable for most ear infections. In cases of mild otitis externa, over-the-counter ear droplets with peroxide and/or boric acid may be used, but this should be initiated by a doctor for people with recurring ear infections.


Ear infections can be associated with a myriad of complications, which is why early diagnosis and treatment are so important. Here are a few:

  • Perichondritis can lead to permanent and severe deformation of the pinna.
  • Otitis externa can lead to malignant otitis externa in which the bones around the ear also get infected. Treatment can take months with multiple surgeries and months of antibiotics, and permanent nerve injuries may occur.
  • Otitis media (both acute and chronic) can lead to facial paralysis, hearing loss, brain abscesses, meningitis, and hydrocephalus (fluid build-up in the brain). Many of the complications are neurosurgical or otolaryngological (ear nose throat [ENT]) emergencies.
  • Untreated labyrinthitis is associated with permanent hearing loss and tinnitus. With their impact on hearing health, the use of hearing aids for the affected ear might be required after such an infection, especially if left untreated.

When to seek medical attention

All ear infections will benefit from a visit to the healthcare provider. As treatment in the early stages for most infections is simple and the potential complications are severe, the threshold for a healthcare visit should be very low in severe ear pain, ear discharge or newly developed hearing loss. 


Ear infections, especially adult ear infections are not to be taken lightly. There are effective ways to prevent ear infections, but if they develop, a visit to the doctor should never be delayed with home remedies.


  1. Perichondritis: Medlineplus medical encyclopedia [Internet]. MedlinePlus. U.S. National Library of Medicine; [cited 2022Nov18]. Available from:
  2. Meghanadh DKR. Find the symptoms of ear infection - middle, inner, outer [Internet]. Medy Blog. Medy Blog; 2022 [cited 2022Nov18]. Available from:
  3. Wang M-C, Liu C-Y, Shiao A-S, Wang T. Ear problems in swimmers. Journal of the Chinese Medical Association. 2005;68(8):347–52.
  4. Leichtle A, Hoffmann TK, Wigand MC. Otitis media – definition, Pathogenese, Klinik, Diagnose und Therapie. Laryngo-Rhino-Otologie. 2018;97(07):497–508.
  5. Bernstein JM. Role of allergy in eustachian tube blockage and otitis media with effusion: A Review. Otolaryngology–Head and Neck Surgery. 1996;114(4):562–8.
  6. Mills R, Hathorn I. Aetiology and pathology of otitis media with effusion in adult life. The Journal of Laryngology & Otology. 2016;130(5):418–24.
  7. Wallis S, Atkinson H, Coatesworth AP. Chronic otitis media. Postgraduate Medicine. 2015;127(4):391–5.
  8. Taxak P, Ram C. Labyrinthitis and Labyrinthitis Ossificans - A case report and review of the literature. Journal of Radiology Case Reports. 2020;14(5).
  9. Robinson AC. Evaluation for waterproof ear protectors in swimmers. The Journal of Laryngology & Otology. 1989;103(12):1154–7.
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Mert Gurcan

Doctor of Medicine - MD, Medicine, Istanbul University-Cerrahpasa

Dr. Mert Gurcan is a Medical Doctor with extensive experience in conducting, directing, publishing, and presenting clinical research. He is passionate about making positive differences in the lives of individuals and their communities through research and promoting public and personal health solutions that help people live healthier and happier lives.
Having completed part of his medical school in the Charite Universitätsmedizin in Berlin, Dr. Gurcan graduated in 2020 from the Istanbul University - Cerrahpasa Medical Faculty with honors and many academic publications and he practiced for two years in Istanbul as both an emergency practicioner and an ENT trainee and is continuing his career in clinical medicine in the United Kingdom.

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