The most common sign of an ear infection is pain in one or both ears, often accompanied by muffled hearing and sometimes fever. But the specific symptoms vary depending on which part of the ear is affected and whether the person is an adult or a young child who can’t describe what they’re feeling. Here’s how to recognize each type.
Middle Ear Infection Signs
A middle ear infection is the most common type, especially in children. In adults, the primary symptoms are pain in one or both ears, muffled hearing, drainage from the ear, and a sore throat. You may also develop a fever, and in rare cases your balance can be affected.
The pain typically worsens when lying down because the position increases pressure on the inflamed eardrum. This is why ear infections often become most noticeable at night. If symptoms don’t improve within two to three days, the infection likely needs antibiotic treatment rather than resolving on its own.
How It Looks in Babies and Toddlers
Young children can’t tell you their ear hurts, so you have to read their behavior instead. The hallmark signs are fussiness (particularly when lying down) and fever. Babies may have trouble sleeping, refuse to eat, or cry more than usual.
One common misconception: a baby tugging at their ears doesn’t necessarily signal an infection. According to Johns Hopkins Medicine, children frequently pull or play with their ears because it’s soothing, especially during teething or when they’re trying to fall asleep. Ear pulling on its own, without fever or obvious discomfort, usually isn’t cause for concern.
Other behavioral clues to watch for include not responding when you call their name, asking you to repeat yourself or turn up the TV volume, talking unusually loudly, wanting to play alone, and general sleepiness or lack of concentration. These signs often point to hearing loss from fluid buildup behind the eardrum.
Outer Ear Infection (Swimmer’s Ear)
An outer ear infection affects the ear canal rather than the space behind the eardrum. The easiest way to distinguish it: pain gets noticeably worse when you touch or wiggle the earlobe. With a middle ear infection, touching the outer ear doesn’t change the pain.
Other symptoms of an outer ear infection include:
- Itching inside the ear canal, often the earliest symptom
- Redness and swelling of the outer ear
- A plugged-up feeling or muffled hearing
- Drainage from the ear
- Pain that spreads to the head, neck, or side of the face
- Swollen glands in the upper neck or around the ear
This type is called swimmer’s ear because water trapped in the ear canal creates a moist environment where bacteria thrive. But it can also develop from using cotton swabs, wearing earbuds for extended periods, or anything else that irritates or scratches the ear canal lining.
Fluid Behind the Eardrum Without Active Infection
Sometimes fluid collects behind the eardrum after an ear infection clears up, or it builds up gradually without a bacterial infection at all. This condition, sometimes called glue ear, doesn’t always cause pain, which makes it easy to miss.
The main symptom is hearing loss. Sound waves can’t vibrate properly through fluid-filled space, so everything sounds muffled. You might also notice a feeling of pressure or fullness in the ear, a popping sensation when swallowing, ringing or buzzing sounds, and occasional balance problems. In children, the behavioral signs described above (not responding to their name, turning up volume, talking loudly) are often the first indication.
Inner Ear Infection Signs
Inner ear infections are less common but more disruptive. The inner ear controls both hearing and balance, so when it becomes inflamed, the symptoms extend well beyond ear pain. The onset is often sudden.
The defining symptom is vertigo, a spinning sensation that can be severe enough to cause nausea and vomiting. Unlike the mild unsteadiness that occasionally accompanies a middle ear infection, inner ear vertigo is continuous and can make it difficult to walk or stand. Other symptoms include significant hearing loss, ringing in the ears, blurred vision, difficulty concentrating, and involuntary eye movements.
What a Doctor Sees During an Exam
When a doctor looks inside your ear with a handheld scope, they’re checking the eardrum for specific changes. A healthy eardrum is translucent and moves freely when a small puff of air is applied. An infected eardrum typically bulges outward from fluid pressure behind it and appears intensely red. If the eardrum doesn’t move when air is puffed against it, that confirms fluid is trapped in the middle ear space. In some cases, the eardrum ruptures on its own, producing visible drainage. This actually relieves pressure and pain, and the eardrum usually heals within a few weeks.
Signs That Need Immediate Attention
Most ear infections resolve within a few days, either on their own or with antibiotics. But in rare cases, untreated infection can spread to the mastoid bone, the hard bump you can feel directly behind your ear. This complication, called mastoiditis, produces a distinct set of warning signs: throbbing ear pain that won’t go away, swelling or redness behind the ear, the ear appearing to stick out farther than the other side, pus draining from the ear, worsening hearing loss, and the bone behind the ear feeling soft or doughy rather than firm.
More serious red flags include high fever, severe headache, confusion, double vision, vertigo, and any weakness in the facial muscles. Without treatment, the infection can spread to tissues surrounding the brain or enter the bloodstream. These complications are rare, but ear pain that keeps getting worse rather than improving after two to three days warrants a medical visit rather than continued waiting.