Ear infection symptoms: What are the early signs of an ear infection?

Overview: What does an ear infection feel like?

Ear infections, specifically acute otitis media, are more likely to occur in children than adults due to anatomical differences in their eustachian tubes and adenoids. Eustachian ear tubes are narrow tubes that run from the middle ear to the back of the throat, where they open and close to regulate air pressure in the middle ear and drain secretions. If eustachian tubes become blocked, fluid can build up in the middle ear. If it becomes infected, this causes the symptoms of an ear infection. In children, eustachian tubes are narrower and more horizontal than in adults, making them more likely to get clogged. 

While some ear infections can improve on their own, many require a doctor’s appointment and a prescription for an antibiotic. However, a watchful waiting or delayed prescribing approach is encouraged by many national organizations, given concerns about over-prescribing antibiotics and its contribution to the development of resistance. Additionally, there is evidence that many middle ear infections resolve with only the body’s immune system. 

These more modern approaches are not applied across the board. Circumstances to see medical care include age under six months old, a high fever, pus, discharge, or fluid coming from the ear, worsening symptoms or any symptoms lasting more than two to three days, and hearing loss. 

What are the early signs of an ear infection?

Unfortunately, it may be difficult to catch any early signs of ear infections since they usually start quickly. However, symptoms may extend beyond the onset of a common cold with cough, runny nose, and congestion. 

Other ear infection symptoms

The most common symptoms include ear pain, fever, irritability, decreased appetite, vomiting, and diarrhea. 

Ear infection symptoms in children

Ear infections are more common in children than adults, and often children cannot verbalize pain. It is important to look for symptoms such as increased ear pulling, trouble sleeping, increased fussiness, or vomiting. If the infection causes the eardrum to perforate, fluid may drain from the ear.

Ear infection vs. swimmer's ear symptoms

Swimmer’s ear is another type of ear infection in the outer ear canal rather than the middle ear. This may be referred to as otitis externa. The most common bacterial pathogens associated with each are unique, which may drive differences in antibiotics needed for treatment. 

Stages of an ear infection

It’s obvious for an adult to realize they have an ear infection, as ear pain is disruptive. For children, especially non-verbal infants, it might be more difficult to elucidate any sort of onset of symptoms. Increased crankiness and fussiness, especially after cold-like symptoms such as a sore throat, runny nose, or cough, indicate a more severe condition. Because ear infections often resolve on their own, initial treatment would include managing pain and monitoring if symptoms don’t improve or get worse. However, if ear pain is severe and not resolved by over-the-counter pain medications, symptoms are not improving, or fluid discharge—like pus or blood—from the ear occurs, seek medical attention. 

When to see a doctor for ear infection symptoms

Certain patients shouldn’t wait to see a healthcare provider with the onset of any symptoms that might be a sign of acute otitis media or other ear infections. Those include children less than two years of age, children with certain anomalies like cleft palates, and anyone with persistent high fevers or any type of fluid draining from the ear. Usually, seeing a primary care physician is most appropriate, but if unable to be seen promptly, seeking medical care at urgent care is also a good option. Ear infections are diagnosed by looking inside the ear to examine the eardrum and looking for pus in the middle ear with an otoscope. Ear infections aren’t generally toxic enough to require being seen in an ER. However, sudden onset of headache, a stiff neck, or increased lethargy may represent a medical emergency. 

Complications of ear infections

Ear infections are generally benign, but it is important to be aware of a few potential serious complications.  One potential complication more common with frequent ear infections is hearing loss, which may slow language and speech development in young children. Tears of the eardrum may also occur and usually heal within several days, but a surgical repair may be needed in some circumstances. Persistent middle ear infections can result in mastoiditis. A stiff neck with headache, significant lethargy, or decreased responsiveness is also a reason for concern for a very rare but serious infection known as meningitis. 

How to treat ear infection symptoms

Ear infections don’t always require treatment. The symptoms may be managed with supportive care. Treatment includes analgesics for pain and antipyretics for fever, such as acetaminophen and ibuprofen. Additional home remedies may be implemented. If symptoms are not improving or fevers remain high by three days, it’s time to see a medical professional. Young children and other individuals shouldn’t wait to seek medical advice upon the onset of ear pain. If diagnosed with an ear infection, a course of antibiotics in drug classes like penicillins, cephalosporins, or macrolides will likely be prescribed. Ear drops, such as  Ciprodex,  may be used in addition to quickly ease the pain.  

Living with ear infections

Ear infections aren’t typically a recurring issue, but some causes increase the likelihood of reinfection, such as allergies, ear injuries, poor air quality, and differences in bone structure or muscles. Other risk factors, like younger age, group child care, and bottle feeding, are all considered to put children at higher risk for developing an ear infection. 

Ways to reduce the risk and prevent ear infections include avoiding the common cold and other illnesses through infection prevention techniques like handwashing, sharing utensils are cups, and coughing or sneezing into an elbow. Breastfeeding, holding babies in a more upright position when bottle-feeding, and using a pacifier may help prevent ear infections. Finally, keeping up to date on immunizations against pathogens commonly associated with ear infections, like the pneumococcal vaccine, is crucial. Some children require placement of tympanostomy tubes or may need to have their adenoids surgically removed if they experience recurring ear infections. 

FAQs about ear infection symptoms

What does an ear infection feel like?

Ear infections feel like pain and pressure in your ear, altering your hearing and balance. Dizziness and nausea may also be present. 

Will an ear infection go away on its own?

Ear infections often resolve on their own. If symptoms don’t resolve or are getting worse by day three, it’s time to see a medical provider. In children less than two years of age, don’t wait to see your provider. 

What can be mistaken for an ear infection?

Earaches without infection can occur when air and fluid build up behind the eardrum. Disorders associated with TMJ (temporomandibular joint), which can result from teeth grinding or arthritis, may also cause some pain that radiates into the ear. Ear canal injuries, such as from a cotton swab or other foreign object, can also be mistaken for an infection. In addition, referred pain is a phenomenon in which ear pain arises from diseases, not in the ear—possibly from tonsil infections or tooth infections. 

What’s next? Additional resources for people with ear infection symptoms

Test and diagnostics

• Otoscopy, StatPearls

• Tympanometry, American Family Physician  

Treatments

• Ear Infection Treatment and Medications, SingleCare

• The Diagnosis and Management of Acute Otitis Media, American Academy of Pediatrics 

• Diagnosis and Treatment of Otitis Media,  American Family Physician

Scientific studies and clinical trials

• Treatment of otitis media by transtympanic delivery of antibiotics, Science Translational Medicine 

More information on related health conditions 

• Otitis media with effusion, Children’s Hospital of Philadelphia

• Swimming and Ear Infections, Centers for Disease Control and Prevention