The most telling sign of an ear infection is persistent ear pain, often described as a deep ache or pressure inside the ear, sometimes accompanied by muffled hearing or fluid drainage. But symptoms look quite different depending on whether the infection is in the ear canal or behind the eardrum, and whether the person affected is an adult or a young child who can’t describe what they’re feeling.
Symptoms in Children
Young children get ear infections far more often than adults, and since they can’t always tell you what hurts, you have to read behavioral cues. The most common signs include tugging or pulling at an ear, crying more than usual, trouble sleeping, fussiness, and loss of appetite. A fever often accompanies the infection, though not always. You may also notice your child having trouble hearing or not responding to sounds the way they normally would.
Loss of balance is another sign that’s easy to miss. The middle ear plays a role in balance, so a toddler who seems unusually clumsy or unsteady may be dealing with fluid buildup behind the eardrum. In some cases, fluid drains from the ear itself, which means the eardrum has torn. This sounds alarming, but small tears typically heal on their own and the drainage often brings pain relief.
Symptoms in Adults
Adults tend to experience ear infections more simply: ear pain or a feeling of pressure, trouble hearing on the affected side, and sometimes fluid drainage. The pain may be constant or come in waves, and it often worsens when lying down because the position increases pressure behind the eardrum. Adults are less likely to develop a fever with a straightforward ear infection, so the absence of fever doesn’t rule one out.
Ear Canal Infection vs. Middle Ear Infection
There are two main types, and they feel different. A middle ear infection causes deep, internal pressure or pain. It often follows a cold or upper respiratory infection, because the tube connecting the back of the throat to the middle ear swells shut, trapping fluid that then becomes infected.
An ear canal infection (sometimes called swimmer’s ear) affects the outer part of the ear. The key difference: pain gets worse when you pull on your earlobe, chew, or move your jaw. The discomfort can range from itching to severe pain triggered by any motion of the ear. You might also see redness or swelling at the ear opening. With a middle ear infection, tugging on the outer ear typically doesn’t change the pain at all.
This simple test, gently pulling the earlobe to see if pain increases, is one of the quickest ways to distinguish between the two types at home.
What a Doctor Looks For
When a healthcare provider examines the ear, they look at the eardrum’s color, shape, and movement. A healthy eardrum is translucent and pearly gray. An infected one often appears red, swollen, or visibly bulging outward from fluid pressure behind it.
To check for trapped fluid, many providers use a device that puffs a small amount of air against the eardrum. A normal eardrum flexes back and forth easily. If it barely moves, fluid is almost certainly present behind it. This technique is more reliable than visual inspection alone, because the eardrum can sometimes look relatively normal even when fluid is trapped behind it. If the eardrum doesn’t move with slight air pressure, a middle ear effusion is highly likely.
Not Every Earache Is an Infection
Ear pain has several non-infection causes that can mimic or be mistaken for an ear infection. One of the most common is a problem with the temporomandibular joint (TMJ), the hinge connecting your jawbone to your skull, located right next to the ear canal. Pain and inflammation in this joint can radiate directly into the ear, sometimes accompanied by ringing or a feeling of fullness. If your ear pain gets worse with chewing, jaw clenching, or teeth grinding, TMJ dysfunction may be the cause rather than an infection.
Sinus congestion can also create intense pressure that feels like an ear infection, especially during allergy season or a bad cold. In children, teething can cause fussiness and ear-pulling that looks identical to ear infection behavior. The difference is that teething pain doesn’t come with fever, fluid drainage, or hearing changes.
When Symptoms Need Immediate Attention
Most ear infections resolve without serious complications, but some warning signs should prompt quick medical attention. Watch for swelling or redness of the skin behind the ear, an ear that appears to stick out more than the other side, or bone behind the ear that feels soft or doughy when pressed. These are signs of mastoiditis, a bacterial infection that has spread from the middle ear into the bone behind it.
Other red flags include a fever that keeps climbing, pus draining from the ear, worsening hearing loss, vertigo, confusion, double vision, or facial weakness on the affected side. Mastoiditis can lead to serious complications including partial hearing loss, meningitis, and widespread infection if left untreated. Persistent ear pain that isn’t improving after two to three days also warrants a visit.
What Happens After Diagnosis
Not every confirmed ear infection requires antibiotics right away. Current guidelines support a “watchful waiting” approach for many children, meaning you observe for two to three days to give the immune system a chance to clear the infection on its own. This approach is appropriate for children between 6 months and 23 months if only one ear is infected, symptoms have lasted less than two days, pain is mild, and temperature is below 102.2°F. For children 2 and older, the same criteria apply even if both ears are involved.
During the waiting period, pain management is the priority. If symptoms worsen, don’t improve within that window, or the child is under 6 months old, antibiotics are typically started. For ear canal infections, treatment usually involves prescription eardrops rather than oral antibiotics.
Most middle ear infections clear within a week to ten days, though fluid behind the eardrum can linger for weeks or even months after the infection itself is gone. This residual fluid can temporarily affect hearing, which is worth knowing if your child seems slow to respond to sounds even after feeling better.