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Key points
- Adults most commonly get outer ear infections (swimmer's ear), caused by water trapped in the ear canal that promotes bacterial growth — primarily Pseudomonas aeruginosa.
- Swimmer's ear is treated with prescription eardrops; oral antibiotics are only needed when infection spreads beyond the ear canal or the patient is immunocompromised.
- Middle ear infections (otitis media) are less common in adults than in children but do occur, especially after upper respiratory infections.
- Watchful waiting (no immediate antibiotics) is appropriate for mild-to-moderate middle ear infections in adults; symptoms typically improve within 2–3 days.
- See a doctor if ear pain is severe, if you have discharge from the ear, if hearing loss develops, or if symptoms don't improve within 72 hours of home management.
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Ear infections aren't just a childhood problem. Adults get them too — particularly outer ear infections (swimmer's ear) after summer swimming, and middle ear infections following upper respiratory illnesses. According to AAFP clinical guidance, outer ear infections are among the most common conditions seen in primary care and urgent care offices during warm months. Understanding the type of infection helps determine whether you need eardrops, oral antibiotics, or just watchful waiting.
What are the different types of ear infections adults get?
Adults primarily develop two types of ear infections. Acute otitis externa — commonly called swimmer's ear — is an infection of the outer ear canal. It typically results from water trapped in the canal that creates a warm, moist environment where bacteria thrive. StatPearls (NIH) notes that Pseudomonas aeruginosa and Staphylococcus aureus are the primary culprits. Acute otitis media is a middle ear infection — less common in adults than in children, but it does occur, usually secondary to eustachian tube dysfunction during or after an upper respiratory infection. The symptoms and treatments for these two types are meaningfully different.
What are the symptoms of swimmer's ear?
Swimmer's ear causes pain — often significant — in the outer ear that characteristically worsens when you pull the outer ear (pinna) or press on the tragus (the small cartilage bump in front of the ear canal opening). This pain-on-traction sign is a key distinguishing feature. Other symptoms include itching inside the canal, a feeling of fullness, and sometimes discharge. Hearing may become muffled if swelling or discharge blocks the canal. According to AAFP clinical guidelines on acute otitis externa, symptoms range from mild itching and discomfort to severe pain, swelling, and tenderness of adjacent lymph nodes in more advanced cases.
How is swimmer's ear treated?
Topical antibiotic eardrops are the first-line treatment for swimmer's ear, according to AAFP clinical guidelines. Available options include acidifying drops (acetic acid 2%), aminoglycoside antibiotics, quinolone antibiotics, and combinations with corticosteroids to reduce swelling. The AAFP notes there is no evidence that one preparation is clinically superior to another; choice is based on cost, whether the eardrum is intact, and patient factors. The standard course is 7–10 days. Oral antibiotics are reserved for cases where infection has spread outside the canal, or in immunocompromised patients or those with diabetes — these groups are at higher risk for a serious condition called malignant otitis externa, which can spread to bone.
How is a middle ear infection different from swimmer's ear?
Middle ear infections cause pain felt deep inside the ear, rather than at the ear canal opening. The pain-on-traction sign is absent. Other symptoms include pressure or fullness deep in the ear, muffled hearing, and sometimes fever. Middle ear infections in adults often follow a cold or sinus infection when eustachian tube congestion prevents fluid from draining from the middle ear. PMC research notes that middle ear infections are significantly less common in adults than in children because adult eustachian tube anatomy is less prone to blockage. When they do occur in adults, they are often more severe.
Do adult middle ear infections need antibiotics?
Not always. AAFP guidance supports watchful waiting for 2–3 days for healthy adults with mild-to-moderate middle ear infections, because many resolve without antibiotics. Pain management with ibuprofen or acetaminophen is appropriate during this window. Antibiotics are recommended if symptoms are severe (significant pain, fever above 102.2°F), if symptoms worsen or do not improve within 48–72 hours, if both ears are affected, or if there is ear discharge. When antibiotics are indicated, amoxicillin is typically first-line.
When should you see a doctor for an ear infection?
See a doctor promptly if ear pain is severe or worsening, if you notice discharge or fluid draining from the ear, if hearing loss develops, if you have a fever, or if symptoms do not improve within 72 hours of home care. People with diabetes, a weakened immune system, or a history of ear surgery should seek evaluation sooner — they face a higher risk of serious complications. Do not insert cotton swabs into the ear canal, which can push debris deeper and irritate the infected tissue.
How Solv can help
Ear infections in adults are straightforward to diagnose and treat — and urgent care can usually handle it in a single visit with no appointment needed. A provider can look in the ear, determine whether it's swimmer's ear or a middle ear infection, and prescribe the right drops or antibiotic if needed. Find a nearby urgent care and book at https://www.solvhealth.com/.
Frequently asked questions
What does an ear infection feel like in adults?
Outer ear infections (swimmer's ear) typically cause pain that worsens when you pull on the outer ear or push the tragus (the small bump in front of the ear canal), along with itching, discharge, and a feeling of fullness. Middle ear infections cause deeper ear pain, pressure or fullness, muffled hearing, and sometimes fever. The location and character of pain helps distinguish the two.
Do adult ear infections go away on their own?
Outer ear infections generally require prescription eardrops to clear the bacterial infection; they don't reliably resolve without treatment. Middle ear infections in adults are more likely to resolve on their own within 2–3 days for mild cases. The AAFP notes that watchful waiting with pain management is appropriate for healthy adults with mild-to-moderate middle ear infections.
How do you prevent swimmer's ear?
The CDC recommends tilting your head to drain water from each ear after swimming or showering, using a towel to gently dry the outer ear, and wearing earplugs if you are prone to infections. Avoid inserting cotton swabs into the ear canal, which can irritate the canal lining and push wax deeper.
Are antibiotics always needed for an ear infection?
No. For outer ear infections, topical antibiotic eardrops are the first-line treatment — oral antibiotics are only added for severe cases or if infection spreads. For middle ear infections in adults, watchful waiting without antibiotics is appropriate for mild-to-moderate cases. Antibiotics are recommended if symptoms are severe or don't improve within 2–3 days.
Can urgent care treat ear infections?
Yes. Urgent care providers can examine the ear with an otoscope, diagnose the type of infection, prescribe antibiotic eardrops for swimmer's ear, and prescribe oral antibiotics for middle ear infections that require them — all in a single visit without waiting for a primary care appointment.
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Dr. Linda Halbrook is a Board-Certified Family Medicine physician with over 40 years of experience, dedicated to providing comprehensive care to patients across Texas. She retired from practice but currently serves on the Clinical Services Committee of CommonGood Medical, a non-profit organization serving the uninsured in Collin County.
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5 sources
Solv has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
- Acute Otitis Externa: Rapid Evidence Review. American Academy of Family Physicians. (Feb 1, 2023)
- Otitis Externa. StatPearls — NCBI Bookshelf. (Jan 1, 2024)
- Acute Otitis Externa: An Update. American Academy of Family Physicians. (Dec 1, 2012)
- Otitis Externa: Investigation and Evidence-Based Treatment. PMC. (May 1, 2019)
- Description of Diagnoses and Antibiotic Management of Otitis Media and Otitis Externa in Adults. PMC. (Nov 29, 2018)
Solv’s team of medical writers and experts review and update our articles when new information becomes available.
July 13 2026
Written by Solv Editorial Team
Medically reviewed by: Dr. Rob Rohatsch, MD
June 02 2026
Edited by Solv Editorial Team
