Ear infections cause a recognizable pattern of symptoms: pain in or around the ear, a feeling of fullness or pressure, muffled hearing, and often a fever. The specific signs depend on which part of the ear is infected and whether the person is an adult, a verbal child, or a baby too young to tell you what hurts. Here’s how to identify each type.
Symptoms in Adults
A middle ear infection in adults typically starts with pain in one or both ears, along with a sensation that the ear feels full or blocked. Your hearing may sound muffled, and you might develop a sore throat or low-grade fever. In rare cases, your balance feels off. These symptoms often follow a cold or upper respiratory infection, since the swelling can trap fluid behind the eardrum.
Signs in Babies and Young Children
Children under two or three can’t describe ear pain, so you have to read their behavior. The National Institute on Deafness and Other Communication Disorders lists these signs to watch for:
- Tugging or pulling at one or both ears
- Unusual fussiness and crying, especially when lying down (the position increases pressure in the middle ear)
- Trouble sleeping
- Fever, particularly in infants and toddlers
- Fluid draining from the ear
- Clumsiness or balance problems
- Not responding to quiet sounds
Crying that intensifies at bedtime or during feeding (when swallowing changes ear pressure) is one of the more reliable clues in very young babies.
Ear Infection vs. Teething
Both ear infections and teething can cause fussiness and ear pulling in infants, which makes them easy to confuse. The clearest difference is fever. Teething may cause a mild temperature rise, but a fever above 100.4°F points more strongly toward an ear infection or another illness. Teething also brings swollen gums, increased drooling, and a need to chew on objects, none of which are ear infection symptoms.
Duration matters too. Teething discomfort tends to be mild and short-lived. If your baby’s symptoms worsen over a day or two, persist for more than a few days, or include fluid draining from the ear, an infection is the more likely explanation.
Middle Ear vs. Outer Ear Infection
Ear infections fall into two common categories, and knowing which one you’re dealing with helps explain what you’re feeling and what treatment looks like.
A middle ear infection (otitis media) sits behind the eardrum. It causes deep ear pain, muffled hearing, a feeling of fullness, and often fever. It’s the most common type in children and frequently follows a cold. Most middle ear infections resolve on their own without antibiotics.
An outer ear infection (otitis externa, often called swimmer’s ear) affects the ear canal itself. The hallmark is pain and itchiness that gets worse when you tug on your earlobe or press near the ear opening. The canal may feel blocked, and you might notice redness or swelling around the outer ear. Outer ear infections are treated with antibiotic ear drops rather than oral antibiotics.
If the pain is deep and your hearing sounds muffled, think middle ear. If the pain is triggered by touching or pulling the outer ear and there’s itchiness, think outer ear.
What Ear Drainage Tells You
Fluid leaking from the ear is one of the most definitive signs of infection, and its color gives useful information. Thick yellow fluid usually means the eardrum has burst from pressure buildup. This often comes with a sudden drop in pain, because the pressure releases. It sounds alarming, but most ruptured eardrums heal on their own within a few weeks.
White, yellow, or green fluid that drains without much pain can signal a chronic middle ear infection, where the eardrum hasn’t fully healed and fluid continues to seep out. This warrants medical attention even if it doesn’t hurt.
Clear fluid from the ear is less commonly from an infection. It can come from eczema in the ear canal. In rare, serious cases following a head injury, clear or blood-tinged fluid can indicate a cerebrospinal fluid leak, which is a medical emergency.
When Dizziness or Balance Problems Appear
Your inner ear controls both hearing and balance. When an infection reaches this deeper part of the ear, it inflames either the labyrinth (the structure responsible for balance and hearing) or the vestibular nerve (which controls balance and eye movement). The result is vertigo, a spinning sensation that can be intense and disorienting, along with dizziness and difficulty staying steady on your feet.
Inner ear infections are less common than middle or outer ear infections, but they’re more disruptive to daily life. Left untreated, they can cause lasting damage to the vestibular system. If you’re experiencing vertigo alongside ear pain or hearing changes, that’s a sign the infection may have spread deeper.
How Doctors Confirm an Ear Infection
Doctors diagnose ear infections by looking at the eardrum through an otoscope, a handheld device with a light and magnifying lens. They’re looking for specific visual signs: moderate to severe bulging of the eardrum, intense redness, or fluid visible behind the membrane. They may also use a puff of air (pneumatic otoscopy) to check whether the eardrum moves normally. A healthy eardrum flexes easily; one backed by trapped fluid barely moves.
According to guidelines from the American Academy of Pediatrics, an ear infection should not be diagnosed if there’s no evidence of fluid behind the eardrum. Pain alone isn’t enough. This is why at-home diagnosis is tricky: you can suspect an ear infection based on symptoms, but confirming it requires seeing the eardrum.
Consumer-grade otoscopes are available, and Johns Hopkins researchers have developed AI-powered versions that can identify infections with accuracy comparable to a specialist. For now, though, these tools are most useful when paired with a telehealth visit, where you capture images and share them with a doctor in real time.
Red Flags That Need Immediate Attention
Most ear infections are uncomfortable but not dangerous. The complication to watch for is mastoiditis, an infection that spreads to the bone behind the ear. It’s uncommon but serious. Warning signs include:
- Throbbing ear pain that keeps getting worse instead of improving
- Swelling, redness, or a soft, doughy feeling in the bone behind the ear
- One ear visibly sticking out more than the other
- High fever, severe headache, or confusion
- Vertigo or double vision
Without treatment, mastoiditis can lead to hearing loss, facial paralysis, or infections that reach the brain. These complications are rare, but they’re why persistent or worsening symptoms after a few days deserve prompt medical evaluation rather than a wait-and-see approach.