Symptoms of a Middle Ear Infection

When you have ear pain or suspect that your child does, you may be dealing with an ear infection. Infections of the middle ear are called otitis media and they are the most common type of ear infection individuals face. Discomfort, ear drainage, and muffled hearing are all common signs and symptoms, but less-specific ones (irritability, decreased appetite, and others) can also occur. These infections are usually easy to recognize in children who are able to articulate how they are feeling but can be more difficult for parents to identify in infants and toddlers.

The common signs and symptoms of a middle ear infection in adults and children include:

• Ear pain (otalgia), especially just in one ear or when lying down
• Hearing loss: Sounds can be muffled as if you are wearing an earplug in the affected ear.
• A feeling of fullness in the ear
• Feeling like you are ill in general
• Ear drainage (otorrhea)
• Fluid behind the eardrum detected with an electronic ear monitor

Children often have a middle ear infection with a cold or soon after a cold; you can expect that they will have cold symptoms such as a cough and runny nose just before the ear infection sets in. Babies and toddlers obviously can't tell you they are feeling ear pain, so you will need to know the symptoms they commonly show.

In addition to those listed above, look for: 

• Tugging on or holding the ears (this indicates pain, though it may not always be due to an ear infection)
• Showing signs of muffled hearing or hearing loss by not responding to sounds
• Fever of 100 degrees or higher
• Nausea, vomiting, and diarrhea
• Fussiness, irritability, excessive crying, inability to be soothed
• Trouble sleeping, either getting to sleep or staying asleep
• Decreased appetite
• Lethargy; lack of energy or interest in play

The buildup of pressure in the inner ear can cause a ruptured eardrum, with a sudden flow of yellow, green, or bloody drainage from the ear. The ear pain can then subside quickly. You may have ringing in the ear and the spinning sensation of vertigo.

Otitis Media With Effusion

Otitis media with effusion, also called secretory otitis media, is an accumulation of fluid in the inner ear. It can follow a middle ear infection. In other cases, the effusion may have developed due to a blocked eustachian tube without infection, but the fluid traps bacteria that can develop into an ear infection.

Otitis media with effusion often has no symptoms, but it can be accompanied by:

• A feeling of fullness in the ear
• Mild hearing loss (you may turn up the volume on the television or a video)
• Cracking or popping sounds with swallowing

Chronic Otitis Media

Chronic otitis media (repeat infections or ongoing infections) can lead to additional signs and symptoms, as well as indications that complications can be developing. You or your child may have renewed symptoms of an ear infection after having a cold or getting water into the middle ear (due to a perforated eardrum). These may include:

• Hearing loss
• Chronic ear drainage
• Drainage and swelling behind the ear
• Balance issues
• Facial weakness
• Deep ear pain
• Headache
• Confusion
• Fatigue

The eardrum can rupture due to the pressure of the accumulated fluid and pus in the ear. A hole or a small tear develops in the eardrum (tympanic membrane). Usually, this will heal on its own in a few weeks without the need for medical treatment. The spinning sensation you can have with a ruptured eardrum can produce nausea or vomiting. You should see a doctor to get appropriate treatment. If the eardrum fails to heal, it may need surgical repair.

Middle ear infections can cause conductive hearing loss, preventing the transmission of sound from the outer ear to the inner ear. In children, repeated ear infections with conductive hearing loss can impair speech and language development and may cause kids to not be able to locate where sounds are coming from. Children may have more difficulty distinguishing and understanding words when they are in noisy places such as the classroom.

Such infections can contribute to auditory processing disorders. Permanent hearing loss is rare, but it can develop with prolonged and repeated infections.

Chronic otitis media can lead to labyrinthitis and damage to the delicate structures in the ear that help with hearing and maintaining balance. Cysts (cholesteatoma) can also develop in the middle ear. 

Although rare, bacterial otitis media sometimes spread to the mastoid bone (mastoiditis) or to the inner ear. In extremely rare cases, the infection could spread to the brain and cause meningitis or an abscess.

The American Academy of Pediatrics promotes an approach of treating the pain and waiting for two to three days to see if it goes away, as it usually will. You should check with your doctor as to when a child needs to be seen. Ear pain that worsens or doesn't improve, fever, and drainage with blood or pus—especially in a baby under age 6 months—require medical evaluation.

Adults should call their doctor when experiencing ear pain or other symptoms to learn whether they should wait or come in for an examination.

A doctor will be able to confirm the diagnosis by seeing signs of inflammation (redness, bulging) of the eardrum on physical examination.

If you or your child is treated for a middle ear infection, take note of when your doctor says you should have improvement. If the ear doesn't respond to treatment, or if new symptoms are noted, call your doctor or pediatrician. Similarly, if any new symptoms are noted after treatment for otitis media with effusion, mention them to your doctor.