Ear infections cause pain that comes on fast, often alongside muffled hearing and a feeling of fullness or pressure in the ear. The specific combination of symptoms depends on which part of the ear is affected. A middle ear infection (the most common type) feels like deep pressure behind the eardrum, while an outer ear infection causes pain that gets worse when you touch or tug on the outer ear. Knowing the difference helps you figure out what you’re dealing with and how urgently you need care.
Middle Ear Infection Symptoms
A middle ear infection develops behind the eardrum, usually after a cold, sinus infection, or upper respiratory illness. In adults, the three hallmark signs are ear pain or pressure, muffled hearing, and sometimes fluid draining from the ear. The pain tends to feel deep and steady, and it often gets worse when you lie down because the fluid behind the eardrum shifts and increases pressure.
Fever can accompany a middle ear infection but isn’t always present, especially in adults. When it does occur, a temperature of 102.2°F (39°C) or higher signals the need for prompt medical attention. Hearing loss during a middle ear infection is usually temporary, caused by fluid blocking sound transmission through the middle ear. It typically resolves once the infection clears and the fluid drains.
Outer Ear Infection Symptoms
An outer ear infection, often called swimmer’s ear, affects the ear canal rather than the space behind the eardrum. It’s commonly triggered by water trapped in the ear canal or by scratching or inserting objects into the ear. The symptoms overlap with middle ear infections in some ways but have a few distinguishing features:
- Itchiness inside the ear canal, often the earliest sign
- Pain that increases when you tug your earlobe or press on the small flap of cartilage (the tragus) at the front of your ear
- Redness and swelling of the outer ear
- A feeling of fullness in the ear
- Muffled hearing
- Swollen lymph nodes around the ear or upper neck
- Fluid draining from the ear
The tug test is the simplest way to distinguish an outer ear infection from a middle ear infection at home. Gently pull on your earlobe or press on the tragus. If this makes the pain noticeably worse, an outer ear infection is the more likely culprit. Middle ear infections don’t typically respond to external pressure this way because the problem is deeper inside.
Spotting an Ear Infection in Babies and Toddlers
Young children get ear infections far more often than adults, and they can’t tell you what hurts. The behavioral cues to watch for include tugging or pulling at one or both ears, unusual fussiness and crying (especially when lying down), trouble sleeping, and a sudden loss of appetite. Babies may refuse to nurse or take a bottle because swallowing changes the pressure in the ear and intensifies pain.
Balance problems and clumsiness can also signal a middle ear infection in toddlers, since the middle ear plays a role in spatial orientation. If your child seems unsteady on their feet during a cold or seems to not respond to quiet sounds, fluid buildup behind the eardrum is a likely explanation. Fever is more common in infants and younger children with ear infections than in older kids or adults.
Signs of a Ruptured Eardrum
Sometimes a middle ear infection creates enough pressure to tear the eardrum. When this happens, you’ll often notice a sudden sharp pain followed by quick relief, as the pressure behind the eardrum drops. Fluid then drains from the ear, which may look like pus or contain traces of blood. Hearing in that ear will drop noticeably.
A ruptured eardrum sounds alarming, but most small tears heal on their own within a few weeks. The drainage itself is actually a sign that the built-up pressure has been released. Still, any fluid coming from the ear warrants a medical visit to confirm the diagnosis and make sure the infection is treated properly.
What Else Can Cause Ear Pain
Not all ear pain comes from an infection. Jaw joint dysfunction (TMJ problems) is one of the most common mimics. TMJ-related pain typically appears around the jaw, face, or ear and worsens when you chew, speak, or open your mouth wide. You may also notice clicking or popping sounds when moving your jaw, or feel like your jaw range of motion is limited. If your ear pain tracks closely with jaw movement rather than swallowing or lying down, the source is more likely your jaw than your ear.
Dental problems, particularly with upper molars, can also send referred pain to the ear. Sinus infections sometimes create pressure that feels similar to a middle ear infection. The key distinction is that a true ear infection almost always involves some degree of muffled hearing or fullness in the ear, while referred pain from the jaw or teeth usually does not.
How Ear Infections Are Diagnosed
A doctor diagnoses a middle ear infection by looking at the eardrum with a handheld scope. The main thing they’re checking for is whether the eardrum is bulging outward, which indicates fluid and pressure building behind it. A bulging, red eardrum is the strongest visual sign of an active infection. In some cases, they’ll use a small puff of air to see how the eardrum moves. A healthy eardrum flexes easily, while one backed by trapped fluid stays rigid. This technique is 70% to 90% accurate for detecting fluid behind the eardrum.
For an outer ear infection, the diagnosis is more straightforward. The doctor can usually see redness and swelling in the ear canal itself, and the tenderness when pressing on the outer ear confirms it.
When Symptoms Need Prompt Attention
Most ear infections in adults resolve within a few days, and many clear without antibiotics. But certain signs point to something that needs medical care sooner rather than later: a fever at or above 102.2°F, pus or bloody fluid draining from the ear, symptoms that worsen after two to three days instead of improving, or noticeable hearing loss. In children, the threshold for getting checked is lower. Any suspected ear infection in a baby under six months, or symptoms lasting more than two to three days in an older child, is worth a visit.