Ear Infection Symptoms and How to Spot Them

An ear infection is inflammation or infection of the ear, and pain is its signature symptom — but pain alone does not say whether the problem sits in the ear canal (otitis externa) or behind the eardrum (otitis media). Fever, drainage, itching and reduced hearing narrow it down. The diagnosis itself is made by looking at the eardrum.

What an ear infection feels like

• Ear pain, sharp or a dull throbbing ache
• A plugged or pressured ear
• Trouble hearing, usually temporary
• Fever — StatPearls reports about two-thirds of patients with acute otitis media have one, typically low-grade
• Drainage, when the eardrum ruptures or when the canal itself is infected
• Itching, far more typical of the outer ear form
• In babies and toddlers: irritability, crying that cannot be soothed, restless sleep, poor feeding, and sometimes vomiting or diarrhea

MedlinePlus adds a caution worth repeating: tugging on the ear is not always a sign of an ear infection. It is a reason to look, not a diagnosis.

Outer versus middle ear infection

The two share a name in casual speech and almost nothing else — different site, different trigger, different treatment.

	Outer ear infection (otitis externa)	Middle ear infection (otitis media)
Where	Ear canal	Behind the eardrum
Pain	Worse when the tragus or outer ear is tugged	No link to moving the ear
Itching	Common and intense	Uncommon
Fever	Less common	About two-thirds of patients
Usual trigger	Water in the canal — swimming raises the risk about fivefold	A preceding cold or upper respiratory infection
First-line treatment	Topical eardrops	Oral antibiotics, when treatment is indicated

That last row is the one people get wrong. Uncomplicated swimmer’s ear is treated with drops in the canal, not with a systemic antibiotic; StatPearls reports 65% to 90% of cases resolving within 7 to 10 days on that approach.

Why ear pain alone does not confirm it

Acute otitis media has a defined visual standard, not a symptom checklist. StatPearls states the diagnosis requires moderate-to-severe bulging of the eardrum, or new-onset drainage not explained by otitis externa — mild bulging counts only when it comes with recent ear pain or redness. None of that is visible from the outside, which is why the otoscope decides and a list of complaints does not. Ear pain also arrives from places that are not the ear at all; see ear pain causes.

In young children the signs are indirect

A child too young to describe pain still shows it. Ear tugging, fussiness that will not settle, waking through the night, reduced appetite and fever are the practical clues, and the NIDCD adds balance trouble and apparent hearing difficulty. Roughly five out of every six children have at least one ear infection before their third birthday, so the suspicion is usually reasonable. The child-specific picture is covered in ear pain in children causes.

What to do, and what the 48 to 72 hours actually means

This window gets quoted as if it were a healing schedule. It is not — it is a reassessment deadline. The AAP guideline allows observation instead of immediate antibiotics in selected cases, on the condition that a mechanism exists to treat if symptoms persist more than 48 to 72 hours. The same clock runs after treatment starts: an ear that is no better by then gets looked at again rather than waited out.

1. Nothing goes into the ear canal — no objects, no cotton swabs, no liquids chosen at home.
2. Treat the pain. Ibuprofen and acetaminophen are effective for the otalgia and fever, and the guideline recommends analgesia regardless of whether antibiotics are used.
3. Watch the associated signs — fever, drainage, hearing.
4. Get the eardrum examined, which is what separates outer from middle and mild from severe.
5. Finish a prescribed course, even once the pain has gone.

Fluid can linger behind the eardrum for weeks or even months after the infection itself has cleared, so a muffled ear after recovery is common rather than alarming — see clogged ear causes.

When to be seen

• Pain that is severe, or that does not ease within 48 to 72 hours of starting treatment
• Fever alongside the pain — and any fever at all in an infant under 6 months
• Drainage coming out of the ear
• Noticeable hearing loss
• Swelling or redness behind the ear, which is how mastoiditis announces itself; see swelling near ear causes
• Severe pain that stops abruptly, which can mean the eardrum has perforated

This content is informational and does not replace a medical consultation, diagnosis, or treatment. See also ear pain causes and ear pain in children causes.