Ear Pain (infection): Online Diagnosis and Treatment

While middle ear infections are more common in children, they can occur at any age. Acute otitis media, the medical term for a middle ear infection, is the most common infection for which antibiotics are prescribed in the United States.

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform is simple and convenient. You will receive a diagnosis, a treatment protocol, and an appropriate online prescription to treat your ear infection. Telehealth for ear infection treatment makes it easy to consult with a virtual doctor and receive an antibiotic to treat your ear infection quickly and easily, even if you don’t have insurance.

Most ear infections occur in children younger than age 5. Invariably, you put your child to bed with some minor cold symptoms, and within a couple of hours, just when you were ready to go to sleep yourself, they awaken, screaming in pain. Of course, your local doctor’s office and urgent care centers are closed, and you don’t really want to take your sleepy, ill child outside the comfort of your home.

Telehealth for ear infections is the perfect option. You can schedule an online appointment with a virtual doctor using the Telegra MD platform and receive a diagnosis. Your virtual doctor can give you tips on relieving your child’s pain and call in a prescription to a local pharmacy. Online doctors who treat ear infections provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

What Is an ear infection?

An ear infection is a collection of infected fluid in the middle ear space. The ear can be divided into three sections:

• Outer ear: Includes the pinna (ear lobe) and the auditory canal. The boundary between the outer and middle ear is the tympanic membrane (eardrum). Hard collections of ear wax and bacterial infections from water trapped in the ear canal are two common causes of ear pain originating in the outer ear.
• Middle ear: The middle ear extends from the eardrum to the bone surrounding the inner ear. The Eustachian tube drains fluid from the middle ear to the back of the throat and helps equalize pressure between the middle ear and atmospheric pressure. If the Eustachian tube becomes inflamed and swells shut, fluid collects in the middle ear. If the fluid becomes infected, it is called otitis media or an ear infection.
• Inner ear: The complex inner ear comprises the semicircular canals, vestibule, and cochlea. The semicircular canals and vestibule are involved in maintaining balance and understanding your body’s position in space. The cochlea is the organ of hearing.

Ear infections are more common in children because they tend to have more viral infections, and their Eustachian tubes are more horizontal, which makes it easier for them to become occluded.

If pressure builds up too high behind an inflamed eardrum, it can cause a rupture or tear in the eardrum. When this happens, infected fluid from the middle ear drains out of the ear. Because the pressure in the middle ear is relieved, pain will markedly decrease with a ruptured eardrum, but it is not a positive situation because the eardrum may heal with a scar. A scarred eardrum does not vibrate as well because it loses some of its flexibility. This can impact hearing. When young children have three or more ear infections that cause an eardrum perforation within six months, tubes are usually placed in the eardrum to drain the fluid.

Can ear infections Be Treated Through Telehealth?

Yes, ear infections can be treated through telehealth, as long as the patient is able to provide a good history and describe their symptoms. For very young children, an in-person visit for a middle ear infection is more appropriate. If you have had cold symptoms and now feel ear pressure and pain, a middle ear infection is a likely diagnosis. Pain when moving the earlobe is a symptom of an external ear infection.

Consult with a virtual doctor to learn whether a middle ear or outer ear infection is the cause of your symptoms and whether antibiotics or pain relief is the better treatment option.

Telemedicine for ear pain treatment makes it easy to arrange a medical consultation with a virtual doctor to discuss your ear pain and receive a prescription for an antibiotic, the most commonly prescribed middle ear infection treatment. Assuming your Telegra MD virtual doctor agrees that your symptoms are consistent with an ear infection, they will send your online prescription to your local pharmacy electronically so you can get started on treatment as soon as possible.

How Do You Get an Ear Infection?

The most common type of ear infection is a middle ear infection, though infections can also occur in the inner and outer ear.

Middle Ear infection

An ear infection generally starts with a viral cold or upper respiratory infection. Swelling and inflammation in the nose, sinuses, and throat can cause Eustachian tube dysfunction, allowing fluid to collect in the middle ear. Middle ear fluid can make the ear feel full and make it difficult to hear. This is called otitis media with effusion. When the fluid becomes infected with a virus, bacteria, or fungi, it is called acute otitis media.

Outer ear infection

When the outer ear canal becomes inflamed or infected, it is called otitis externa or swimmer’s ear. Water sitting in the ear canal for extended periods is a common cause of an outer ear infection. It can cause maceration of the skin lining the ear canal. The moist, dark, protected environment in the ear canal is a breeding ground for bacteria.

Living in warm, humid environments, wearing hearing aids or earbuds, and excessive collections of hard earwax in the ear canal are risk factors for acute otitis externa.

Ear wax provides a protective coating over the skin lining the ear canal. It also inhibits bacterial and fungal growth. When this protective barrier breaks down, the ear canal becomes an optimal environment for bacterial and fungal growth. Scratching the ear canal can cause further injury.

Inner ear infection

Inner ear infections are rare and typically follow a viral respiratory infection.

What Are the Common Symptoms of an Ear Infection?

Ear infection symptoms vary based on the type and location of the infection.

Middle ear infection symptoms

Symptoms of a middle ear infection include:¹

• Ear pain
• Ear drainage
• Trouble hearing
• Ear pressure
• Irritability
• Fever
• Decreased appetite
• Fatigue
• Sleep problems

Outer ear infection symptoms

Infections of the external auditory canal can cause: ²

• Ear pain
• Itching
• Discharge
• Hearing loss
• Ear fullness
• Ear pain when chewing

Pain that worsens when pulling on the earlobe is a classic sign of external otitis media. Pain may be severe as the canal continues to swell. Fever and fatigue are symptoms that suggest the infection extends beyond the ear canal.²

Inner ear infection symptoms

The symptoms of an inner ear infection are due to inflammation of the semicircular canal and vestibule. Common symptoms include:

• Vertigo
• Hearing loss
• Nausea
• Difficulty walking
• Balance problems
• Vomiting

Inner ear infections may need a more comprehensive evaluation to rule out more serious conditions that cause similar symptoms. Inner ear infections are better managed by making an appointment with your local doctor.

When Should You See a Doctor for an Ear Infection?

See your doctor if you have any of the following signs or symptoms:

• Fever that does not respond to treatment
• Symptoms that don’t improve within 48 hours
• Headache
• Dizziness
• Vomiting
• Stiff neck
• Pain behind your ear
• Fluid or blood draining from your ear
• Facial muscle weakness or paralysis

Complications from a middle ear infection are rare, but they do occur. If pain is not localized to the eardrum, symptoms worsen, or you have systemic symptoms such as fever and fatigue, see an in-person doctor. They will need to look at your eardrum using an instrument called an otoscope to verify whether your symptoms are from a middle ear infection.

Are Some People at Increased Risk of an Ear Infection?

Young children are at increased risk for middle ear infections. Other risk factors for middle ear infections include:¹

• Family history of ear infections
• Male sex
• Premature birth
• Prior ear infections
• Recent viral upper respiratory infections
• Exposure to tobacco smoke or pollution
• Daycare
• Gastroesophageal reflex
• Immune compromise

Risk factors for external ear infections include:

• Swimming
• Living in a warm, humid environment
• Having allergies
• Cleaning ear canals frequently
• Nickel allergy

How Do You Diagnose an Ear Infection?

A middle ear infection is diagnosed based on symptoms and after examining the eardrum. An outer ear infection is a clinical diagnosis. It is characterized by rapid onset with signs and symptoms of outer ear canal inflammation, such as ear pain, itching, and fullness.³

How do You Treat an Ear Infection?

The treatment for an ear infection also varies based on the location of the infection.

Middle ear infection treatment

Middle ear infections are typically treated with antibiotics if they are symptomatic. If you have fluid behind your eardrum and do not have pain, it is better to wait on treatment and see if the fluid resolves on its own. According to the Choosing Wisely Recommendations, children 2 to 12 should wait on starting antibiotics if their symptoms are not severe, and observation for 48 to 72 hours is a reasonable option.¹

Outer ear infection treatment

Treatment for an outer ear infection is focused on controlling pain, treating the infection, and avoiding factors that may worsen the infection. Over-the-counter pain medications and topical steroids are used to control pain. Prescription ear drops are used to treat infection and inflammation.

What Are Some Common Medications Used to Treat an Ear Infection?

Most inner and outer ear infections are bacterial in origin and are treated with antibiotics.

Middle ear infection treatment medications

The most common causes of bacterial ear infections are Streptococcus pneumoniae and nontypeable Haemophilus influenzae. Common antibiotics used to treat middle ear infection include the followings:

• Amoxicillin
• Amoxicillin/clavulanate
• Cefdinir
• Azithromycin

External ear infection treatment medications

Nearly all external ear infections in the U.S. are bacterial in origin. The most common pathogens are Pseudomonas aeruginosa and Staphylococcus aureus. Ear drops that combine an antibiotic and a steroid effectively treat these infections.² Examples of medications used to treat external ear infections include the following:

• Cortisproin ear drops
• Floxin otic drops
• VoSol HC eardrops
• CiproHC ear drops

External ear infections often do not clear up promptly because the ear drops do not reach the site of the infection. If possible, have someone else administer your ear drops.³

Steps for instilling ear drops:¹

1. Lie on your side with the affected ear facing up.
2. Warm the drops by rolling the bottle between your palms.
3. Instill drops into the ear canal until the canal is full.
4. Move the ear lobe back and forth to ensure the ear canal is full.
5. Remain in this position for 3 to 5 minutes.

Sometimes an ear wick is placed into the external auditory canal to allow for deeper penetration of ear drops. If your pain and symptoms do not improve within 2 to 3 days, you should be reevaluated.⁴

Can You Prevent an Ear Infection?

To prevent otitis media:

• Keep your ear as dry as possible by letting any accumulated water run out of your ear after bathing or swimming.
• Avoid putting objects into your ear, such as cotton swabs or ear curettes.
• Wear a swim cap to keep your ears dry.
• Avoid prolonged use of earbuds.
• Get vaccinated when appropriate.

The steps for diagnosing an ear infection after seeing a doctor online through telemedicine are similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient, as many telemedicine companies provide online telehealth services for ear pain treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will determine whether your symptoms are consistent with a middle or outer ear infection.
• Treatment: If you are diagnosed with an ear infection, your virtual doctor will transmit a prescription for ear infection treatment to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Gaddey HL, Wright MT, Nelson TN. Otitis Media: Rapid Evidence Review. Am Fam Physician. 2019 Sep 15;100(6):350-356. PMID: 31524361.

2. Wipperman J. Otitis externa. Prim Care. 2014 Mar;41(1):1-9. doi: 10.1016/j.pop.2013.10.001. Epub 2013 Dec 7. PMID: 24439876.

3. Rosenfeld, R. M., Andes, D., Bhattacharyya, N., Cheung, D., Eisenberg, S., Ganiats, T. G., … & Witsell, D. L. (2007). Clinical practice guideline: adult sinusitis. Otolaryngology-head and neck surgery, 137(3), S1-S31.

4. England, R. J. A., Homer, J. J., Jasser, P., & Wilde, A. D. (2000). Accuracy of patient self-medication with topical eardrops. The Journal of Laryngology & Otology, 114(1), 24-25.

5. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics March 2013; 131 (3): e964–e999. 10.1542/peds.2012-3488