Can ear infections cause ear fullness and hearing issues?

Ear Fullness and Hearing Issues After Ear Infection

Yes, ear fullness and hearing issues can definitely occur after an ear infection and may persist for weeks to months after the infection resolves. 1 This is most commonly due to otitis media with effusion (OME), which is the presence of fluid in the middle ear without signs or symptoms of acute infection.

Pathophysiology and Prevalence

After an acute ear infection (acute otitis media), fluid often remains in the middle ear and can cause:

• Ear fullness/pressure sensation - One of the most common symptoms 1, 2
• Mild to moderate hearing problems - Especially in background noise 1
• Persistence of symptoms - 60-70% of patients have middle ear effusion at 2 weeks, 40% at 1 month, and 10-25% at 3 months after an infection 2

Common Post-Infection Symptoms

The fluid in the middle ear following infection can cause several symptoms:

• Feeling of fullness or blockage in the ear 1, 2
• Mild hearing difficulties, especially in noisy environments 1
• Occasional balance problems or dizziness 2
• Tinnitus (ringing in the ears) 2
• Discomfort or mild pain 1

Natural Course and Management

Most cases of post-infectious ear fullness and hearing issues resolve spontaneously:

• Watchful waiting is recommended for the first 3 months from the onset of effusion 1, 2
• About 30-40% of children have repeated OME episodes, and 5-10% of episodes last ≥1 year 1
• Medical treatments are generally ineffective and should be avoided 1:
  • Antibiotics
  • Antihistamines
  • Decongestants
  • Steroids (oral or intranasal)
  • Acid reflux medications

When to Seek Further Evaluation

Further evaluation is recommended if:

1. Symptoms persist for ≥3 months 1, 2
2. Hearing difficulties are affecting quality of life 2
3. Balance problems or dizziness are significant 2
4. Symptoms are unilateral and persistent (to rule out other causes) 2

Diagnostic Approach

If symptoms persist:

• Pneumatic otoscopy - To visualize middle ear fluid 1, 2
• Tympanometry - Objective measure of middle ear function 1, 2
• Hearing assessment - Especially if symptoms persist beyond 3 months 1, 2

Treatment Options for Persistent Symptoms

If symptoms persist beyond 3 months or significantly affect quality of life:

• Tympanostomy tube placement may be considered, especially with:
  • Documented hearing difficulties 2
  • Vestibular symptoms affecting quality of life 2
  • Recurrent episodes of acute otitis media with middle ear effusion 2

Self-Care Measures

While waiting for natural resolution:

• For hearing difficulties: Stand or sit close when speaking to the affected person, ensure they can see your face, speak clearly, and repeat information when necessary 1
• Avoid smoke exposure, which can worsen and prolong symptoms 1
• For children >12 months: Consider limiting daytime pacifier use 1

Important Considerations

• Ear fullness and hearing issues after infection are usually temporary and resolve on their own 1
• Regular follow-up is important even if symptoms seem mild, as persistent fluid can occasionally lead to structural damage of the eardrum 1, 2
• Persistent unilateral symptoms should be evaluated to rule out other conditions like Ménière's disease 1, 2

Remember that post-infectious ear fullness and hearing issues are common and usually self-limiting, but persistent symptoms warrant medical evaluation to prevent long-term complications.