Medically Reviewed By: Mark Aquino, NP – Urgent Care Nurse Practitioner, author of Physical Assessment for Nurses Simplified. This article is based on real-world urgent care experience and current clinical guidelines.
An ear infection can cause significant ear pain, pressure, muffled hearing, fever, or drainage from the ear. Although ear infections are particularly common in children, adults can develop them too.
But “ear infection” does not describe just one condition.
A middle ear infection, medically called acute otitis media (AOM), develops behind the eardrum. An outer ear infection, or otitis externa, affects the ear canal and is commonly called swimmer’s ear. These conditions can produce similar symptoms but require different treatments.[1-3]
There are also conditions that can feel like an ear infection even when the ear itself is not infected.
That distinction matters because ear pain alone does not prove that someone has an ear infection. A clinician generally needs to examine the ear and eardrum to determine what is actually causing the symptoms.[2,4]
This guide explains the symptoms and causes of ear infections, how healthcare professionals diagnose them, when antibiotics may be appropriate, what you can do for pain, and when ear symptoms require urgent or emergency evaluation.
What Is an Ear Infection?
The ear has three main regions:
- outer ear
- middle ear
- inner ear
Different disorders can affect each area.
When people use the term ear infection, they are most often referring to a middle ear infection.
Middle Ear Infection — Acute Otitis Media
Acute otitis media (AOM) is an infection involving the middle ear, the air-filled space located behind the eardrum.[1]
It frequently develops after a respiratory illness.
Inflammation from a cold, flu, or another upper respiratory infection can cause the eustachian tube connecting the middle ear with the back of the throat to become swollen or blocked.
Fluid can then accumulate behind the eardrum.
Viruses or bacteria may contribute to inflammation and infection in this trapped middle-ear fluid.[1]
Outer Ear Infection — Otitis Externa
Otitis externa affects the external ear canal rather than the space behind the eardrum.
It is commonly known as swimmer’s ear.
Water remaining in the ear canal can create a moist environment that allows bacteria to multiply. Damage to the skin of the ear canal can also increase the risk.[3]
A particularly useful clue is pain when someone:
- pulls on the outer ear, or
- presses on the tragus, the small projection immediately in front of the ear canal.[3]
That finding is much more characteristic of otitis externa than a typical middle ear infection.
What About an Inner Ear Infection?
Patients sometimes use the phrase “inner ear infection” to describe dizziness, vertigo, nausea, or balance problems.
However, true disorders of the inner ear are different from typical middle ear infections.
Conditions such as labyrinthitis or vestibular neuritis can cause significant vertigo and balance symptoms. They require a different evaluation from acute otitis media.
Therefore, dizziness accompanied by ear symptoms should not automatically be assumed to be a routine ear infection.
What Are the Symptoms of an Ear Infection?
Symptoms vary depending on the patient’s age and which portion of the ear is affected.
Ear Infection Symptoms in Children
Children with acute otitis media may develop:
- ear pain
- pulling or tugging at an ear
- increased crying
- irritability
- difficulty sleeping
- fever
- decreased appetite
- difficulty hearing
- decreased response to sounds
- balance problems
- headache
- drainage from the ear.[1]
Young children cannot always tell a caregiver that their ear hurts.
Sudden irritability, poor sleep, or ear tugging after a cold may therefore prompt parents to suspect an ear infection.
However, ear tugging by itself does not establish the diagnosis.
Ear Infection Symptoms in Adults
Adults with a middle ear infection may experience:
- ear pain
- pressure or fullness
- muffled hearing
- decreased hearing
- drainage from the ear.[1]
Adults may also report that the ear feels:
- clogged
- plugged
- underwater
- full of pressure
A recent cold or respiratory infection may precede the symptoms.
Because adults develop acute otitis media less frequently than young children, persistent or recurrent symptoms deserve appropriate evaluation.
What Does an Ear Infection Feel Like?
People often describe ear infection pain as:
- aching
- throbbing
- pressure
- fullness
- sharp pain
- deep pain inside the ear
The discomfort can range from mild to severe.
However, the character of the pain alone cannot reliably determine its cause.
For a broader discussion of conditions that can produce ear discomfort, see our guide to ear pain and its possible causes.
What Causes a Middle Ear Infection?
Middle ear infections frequently begin after another respiratory illness.
Common preceding conditions include:
- common cold
- influenza
- other viral respiratory infections
- nasal congestion
- inflammation involving the nose or throat.[1]
The eustachian tubes normally help:
- equalize middle-ear pressure
- ventilate the middle ear
- drain fluid from the middle ear.[1]
When inflammation blocks these tubes, fluid can accumulate behind the eardrum.
That environment can contribute to an acute middle ear infection.
Why Are Ear Infections More Common in Children?
Children are anatomically more susceptible to middle ear infections.
Their eustachian tubes are narrower and more horizontal than those of adults, which makes drainage less efficient.[1]
Children also experience frequent upper respiratory infections, especially when exposed to other children in daycare or school.
Additional factors associated with childhood AOM include:
- recent upper respiratory infection
- daycare or crowded environments
- tobacco-smoke exposure
- pacifier use beyond infancy
- bottle feeding while lying flat
- previous ear infections.[5]
This helps explain why recurrent ear infections are a common pediatric problem.
Is an Ear Infection Viral or Bacterial?
It can involve viruses, bacteria, or both.
That is one reason antibiotics are not automatically necessary for every child with a suspected middle ear infection.
Some mild cases improve without antibiotics.
The decision to use antibiotics depends on factors including:
- age
- severity of symptoms
- duration of symptoms
- whether one or both ears are affected
- examination findings
- presence of ear drainage
- previous treatment
- underlying medical considerations.[2,5]
The appearance of the eardrum is particularly important.
How Is an Ear Infection Diagnosed?
A healthcare professional usually begins by asking about:
- ear pain
- fever
- recent respiratory illness
- drainage
- hearing changes
- symptom duration
- previous ear infections
- recent swimming
- trauma or objects placed in the ear
The ear is then examined using an otoscope.
This allows the clinician to inspect the ear canal and tympanic membrane, commonly called the eardrum.
What Does an Ear Infection Look Like?
One of the most important findings in acute otitis media is a bulging tympanic membrane.
Current diagnostic criteria emphasize that AOM should not be diagnosed merely because an eardrum looks red.
Diagnosis generally requires findings such as:
- moderate-to-severe bulging of the tympanic membrane,
- new ear drainage not explained by otitis externa, or
- mild bulging associated with recent ear pain or marked redness.[4,5]
Evidence of middle-ear fluid is also important.[4]
This distinction helps prevent unnecessary antibiotic treatment.
A Red Eardrum Does Not Always Mean an Ear Infection
This is an important point.
An eardrum can appear red for reasons other than acute bacterial otitis media.
For example, redness can occur with:
- crying
- fever
- viral illness
- irritation
The clinician therefore considers the shape, position, mobility, and appearance of the eardrum, not simply whether it looks red.
Bulging and middle-ear effusion are much more useful diagnostic findings.[4,5]
Ear Infection vs Fluid Behind the Ear
Another common source of confusion is otitis media with effusion (OME).
OME means fluid is present behind the eardrum without the acute signs and symptoms of an active middle ear infection.[2]
Fluid can remain after an infection has resolved.
This may cause:
- ear fullness
- popping
- muffled hearing
- temporary hearing difficulty
But middle-ear fluid alone does not necessarily require antibiotics.
Mistaking OME for acute otitis media can result in unnecessary antibiotic use.[4,5]
Ear Infection vs Swimmer’s Ear
Although both can cause significant ear pain, the location of infection is different.
| Feature | Middle Ear Infection | Swimmer’s Ear |
|---|---|---|
| Medical term | Acute otitis media | Otitis externa |
| Location | Behind eardrum | Ear canal |
| Often follows | Cold/URI | Swimming/water exposure |
| Pain pulling outer ear | Less characteristic | Common |
| Canal redness/swelling | Usually absent | Common |
| Treatment | Observation or oral antibiotic depending on case | Usually topical ear medication |
Swimmer’s ear commonly causes pain when the outer ear is moved or the tragus is pressed.[3]
It may also cause:
- itching
- canal swelling
- redness
- drainage.[3]
Treatment is therefore different from treatment for a middle ear infection.
Can Earwax Cause Ear Pain?
Yes.
Impacted cerumen, or earwax, can cause:
- pressure
- decreased hearing
- ear fullness
- discomfort
- ringing in the ear
It can sometimes feel like an infection.
Trying to remove wax with cotton swabs can push it farther into the canal or injure the skin.
The CDC specifically advises against placing cotton-tip swabs or other objects inside the ear canal.[3]
Can a Sore Throat Cause Ear Pain?
Yes.
Pain felt in the ear does not always originate in the ear.
The ear shares nerve pathways with structures in the:
- throat
- tonsils
- teeth
- jaw
- neck
This phenomenon is called referred otalgia.
For example, pharyngitis or tonsillitis can sometimes produce ear pain despite a normal ear examination.
If throat symptoms are prominent, see our guide to common causes of a sore throat.
Do Ear Infections Need Antibiotics?
Not every ear infection requires immediate antibiotics.
Some children with mild acute otitis media can be managed initially with pain control and observation.
The CDC describes watchful waiting as observing an eligible child for approximately 2 to 3 days before beginning antibiotics, allowing time for the immune system to resolve a mild infection.[6]
According to CDC guidance, watchful waiting may be considered for selected:
- children 6–23 months with infection involving only one ear, and
- children 2 years and older with infection involving one or both ears,
when symptoms have been present for less than two days, pain is mild, and temperature is below 102.2°F (39°C).[6]
This decision should be made with the child’s healthcare professional rather than by simply ignoring symptoms at home.
When Are Antibiotics More Likely to Be Used?
Antibiotic treatment is more likely when:
- the child is very young
- symptoms are severe
- fever is high
- pain is moderate or severe
- symptoms persist or worsen
- there is certain ear drainage
- both ears are affected in certain younger children
- observation has failed
- clinical circumstances increase the risk of complications.[2,5]
The appropriate antibiotic, dose, and treatment duration depend on the patient’s age, weight, allergy history, recent antibiotic exposure, and clinical presentation.
What Antibiotic Is Used for an Ear Infection?
When antibiotics are indicated for uncomplicated acute otitis media in children, amoxicillin is commonly first-line therapy.[5]
Amoxicillin-clavulanate may be selected in certain circumstances, including recent amoxicillin exposure or concurrent purulent conjunctivitis.[5]
Alternative antibiotics may be considered for patients with particular penicillin allergies.
However, this is exactly why antibiotics should not be chosen simply because someone has ear pain.
The clinician first needs to determine:
- whether an infection is actually present,
- which part of the ear is affected, and
- whether antibiotics are indicated.
Antibiotics intended for another person should never be shared or reused.
What About Antibiotic Ear Drops?
Ear drops are not interchangeable with oral antibiotics.
For example, otitis externa is commonly treated with topical ear medication, whereas uncomplicated acute otitis media involves the space behind an intact eardrum.[3]
Whether an ear drop is safe also depends on whether the eardrum is intact.
Do not place leftover antibiotic drops, peroxide, alcohol, oil, or other substances into an ear with:
- known or possible eardrum perforation
- ear tubes
- unexplained drainage
unless a healthcare professional has confirmed that the product is appropriate.
How Can You Relieve Ear Infection Pain?
Regardless of whether antibiotics are prescribed, pain management is important.[4,5]
Options may include age-appropriate:
Acetaminophen
Acetaminophen can reduce pain and fever.
Follow age- and weight-appropriate dosing instructions.
Ibuprofen
Ibuprofen can also reduce pain and fever when appropriate for the patient.
Parents should use pediatric medications according to their child’s weight and product instructions and ask a healthcare professional or pharmacist when unsure.
Warm compress
A comfortably warm—not hot—compress against the affected ear may provide temporary relief.
Fluids and rest
Children recovering from a respiratory infection may benefit from adequate hydration and rest.
What Should You Avoid Putting in an Infected Ear?
Avoid inserting:
- cotton swabs
- keys
- hairpins
- fingers
- other objects
into the ear canal.
The CDC notes that earwax provides a protective function and advises against inserting objects into the canal.[3]
Also avoid using unprescribed ear drops when there may be a perforated eardrum or ear tubes.
Can an Eardrum Rupture From an Ear Infection?
Yes.
Pressure from fluid accumulating behind the eardrum can occasionally cause a tympanic membrane perforation.
A person may experience:
- significant ear pain followed by sudden relief
- fluid drainage
- pus
- bloody drainage
- temporary hearing changes
Many small perforations heal, but ear drainage or suspected eardrum rupture warrants medical evaluation.
Do not insert medication or other substances into the ear unless a clinician confirms that they are safe with a possible perforation.
How Long Does an Ear Infection Last?
Symptoms of uncomplicated middle ear infections often begin improving within a few days.
Mayo Clinic notes that many ear infections clear within approximately one to two weeks, even though symptom improvement often begins sooner.[2]
Fluid behind the eardrum may persist after the acute infection resolves.
Consequently, temporary:
- fullness
- popping
- muffled hearing
may outlast the pain or fever.
Persistent hearing difficulty should be reassessed.
What If the Ear Infection Isn’t Getting Better?
Reevaluation is appropriate when symptoms:
- worsen
- fail to improve as expected
- return shortly after treatment
- remain severe
- develop despite antibiotics
Possible explanations include:
- incorrect initial diagnosis
- persistent middle-ear infection
- resistant bacteria
- otitis externa
- eardrum perforation
- persistent middle-ear fluid
- referred ear pain
- another ear disorder
The answer is not necessarily “a stronger antibiotic.”
A repeat ear examination may be more useful than automatically changing medication.
Recurrent Ear Infections
Some children experience repeated episodes of acute otitis media.
Tympanostomy tubes, commonly called ear tubes, may be considered for selected children with recurrent infections.
Evidence reviews suggest considering tubes for children with approximately:
- 3 or more episodes within 6 months, or
- 4 episodes within 12 months with at least one episode during the preceding 6 months.[5]
An ENT specialist can determine whether tubes are appropriate.
Persistent middle-ear fluid associated with hearing loss, speech concerns, or structural abnormalities may also require further evaluation.
Can Ear Infections Affect Hearing?
Yes, usually temporarily.
Fluid behind the eardrum interferes with normal sound transmission and can produce muffled hearing.
Hearing generally improves as the fluid resolves.
However, repeated infections or persistent middle-ear effusion can occasionally contribute to longer-lasting hearing problems.[1]
Children are particularly important to monitor because hearing is closely connected with speech and language development.
Persistent hearing concerns warrant evaluation.
Can Ear Infections Cause Dizziness?
Some people with ear problems report dizziness or imbalance.
However, significant vertigo is not something to automatically attribute to uncomplicated acute otitis media.
The inner ear plays an important role in balance.
Conditions affecting the vestibular system can cause:
- spinning sensation
- nausea
- vomiting
- imbalance
- difficulty walking
For more information about distinguishing common dizziness from warning signs, see our guide to dizziness and vertigo symptoms.
When Should You Go to Urgent Care for an Ear Infection?
Urgent care can be appropriate when someone has:
- significant ear pain
- suspected ear infection
- fever with ear symptoms
- new ear drainage
- worsening symptoms
- symptoms not improving after a few days
- suspected swimmer’s ear
- hearing changes associated with an acute illness
An urgent care clinician can examine the ear canal and eardrum and determine whether the problem appears to be:
- acute otitis media
- otitis externa
- middle-ear fluid
- earwax impaction
- eardrum perforation
- another cause of ear pain
That examination is important because these conditions are treated differently.
When Should a Baby or Child Be Evaluated?
Seek medical advice promptly for a young infant with suspected ear infection.
Mayo Clinic specifically recommends contacting a healthcare professional when symptoms occur in a child younger than 6 months, when symptoms are severe or worsening, or when fluid, pus, or blood drains from the ear.[1]
Children should also be evaluated when there is:
- significant or persistent ear pain
- persistent fever
- hearing difficulty
- worsening illness
- recurrent infections
A young child who appears seriously ill should be evaluated urgently regardless of whether an ear infection is suspected.
When Is an Ear Infection an Emergency?
Most uncomplicated ear infections do not require an emergency department.
However, certain symptoms can indicate a complication or a different serious condition.
Seek urgent emergency evaluation for symptoms such as:
- severe illness or lethargy
- confusion or altered mental status
- severe headache with concerning neurologic symptoms
- stiff neck
- seizure
- facial weakness
- rapidly spreading redness or swelling around the ear
- significant swelling or tenderness behind the ear
- an ear that appears pushed outward
- severe dizziness with inability to walk
- sudden significant hearing loss
- significant trauma to the ear or head
One uncommon but important complication of middle ear infection is mastoiditis, an infection involving the bone behind the ear.
Swelling, redness, or marked tenderness behind the ear—particularly when the ear begins protruding outward—requires prompt medical evaluation.
Frequently Asked Questions
How do you know if you have an ear infection?
Symptoms such as ear pain, pressure, fever, hearing changes, or drainage may suggest an ear infection, but symptoms alone cannot reliably confirm one.
A clinician typically examines the ear canal and eardrum with an otoscope. Bulging of the tympanic membrane and evidence of middle-ear fluid are particularly important findings in acute otitis media.[4,5]
Can an ear infection go away on its own?
Yes.
Some mild middle ear infections improve without antibiotics.
Selected children may qualify for a 2-to-3-day watchful-waiting period under the guidance of a healthcare professional.[6]
However, age, severity, examination findings, and other clinical factors determine whether observation is appropriate.
Can adults get ear infections?
Yes.
Middle ear infections are considerably more common in children, but adults can develop them.
Adult symptoms may include ear pain, pressure, drainage, and hearing changes.[1]
Persistent or recurrent adult ear symptoms deserve evaluation.
Does ear pain always mean an infection?
No.
Ear pain can result from:
- earwax
- swimmer’s ear
- pressure changes
- eustachian tube dysfunction
- dental problems
- temporomandibular joint disorders
- throat infections
- trauma
- foreign objects
- other conditions.
An ear examination helps distinguish these possibilities.
Does a red eardrum mean antibiotics are needed?
Not necessarily.
Redness alone is not enough to reliably diagnose acute otitis media.
Bulging of the tympanic membrane and evidence of middle-ear effusion are much more important diagnostic findings.[4,5]
Is swimmer’s ear the same as a middle ear infection?
No.
Swimmer’s ear affects the external ear canal, while acute otitis media occurs behind the eardrum.
Pain when pulling the outer ear or pressing the tragus strongly suggests swimmer’s ear.[3]
Treatment also differs.
Can an ear infection cause hearing loss?
Yes.
Fluid behind the eardrum can temporarily reduce hearing.
Persistent fluid, recurrent infections, or prolonged hearing changes should be evaluated, particularly in children because hearing problems can affect speech and language development.[1]
Should I use leftover ear drops?
No.
Different ear conditions require different medications, and some drops may be inappropriate when the eardrum is perforated.
A clinician should determine what type of ear problem is present before treatment.
Can I clean an infected ear with a cotton swab?
Avoid inserting cotton swabs into the ear canal.
They can push wax deeper, irritate the skin, or cause injury. The CDC recommends against putting cotton-tip swabs or other objects into the ear canal.[3]
The Bottom Line
An ear infection most commonly refers to acute otitis media, an infection involving the middle ear behind the eardrum. It is especially common in children and often develops after a respiratory infection causes swelling and obstruction of the eustachian tubes.[1]
Ear pain alone does not prove that an infection is present. A proper diagnosis usually requires examination of the ear canal and eardrum. A bulging tympanic membrane with middle-ear fluid is much more characteristic of acute otitis media than redness alone.[4,5]
Not every middle ear infection requires antibiotics. Selected children with mild symptoms may be candidates for watchful waiting for 2 to 3 days, while younger children, severe infections, persistent symptoms, or certain examination findings are more likely to require antibiotic treatment.[2,5,6]
Outer ear infections, middle ear infections, earwax, persistent fluid, referred throat or jaw pain, and inner-ear disorders can all produce overlapping symptoms but require different treatment.
Seek prompt medical care for severe or worsening symptoms, drainage from the ear, significant hearing changes, or persistent pain. Swelling or redness behind the ear, facial weakness, severe dizziness, neurologic symptoms, or serious illness requires urgent evaluation.
References
- Mayo Clinic Staff. Ear infection (middle ear): symptoms and causes. Mayo Clinic. Updated April 23, 2025.
- Mayo Clinic Staff. Ear infection (middle ear): diagnosis and treatment. Mayo Clinic.
- Centers for Disease Control and Prevention. Preventing swimmer’s ear. Updated May 28, 2025.
- Earwood JS, Rogers TS, Rathjen NA. Ear pain: diagnosing common and uncommon causes. Am Fam Physician. 2018;97(1):20-27.
- Gaddey HL, Wright MT, Nelson TN. Otitis media: rapid evidence review. Am Fam Physician. 2019;100(6):350-356.
- Centers for Disease Control and Prevention. Watchful waiting for ear infections. CDC Be Antibiotics Aware.
Medical Disclaimer
This article is for general educational purposes and is not intended to diagnose an individual medical condition or replace evaluation by a qualified healthcare professional. Ear symptoms can have multiple causes, and appropriate treatment depends on age, medical history, examination findings, medication allergies, and other factors. Medication recommendations for children should be based on appropriate age and weight. If you believe you or your child may be experiencing a medical emergency, seek emergency medical care.
About the author: Mark Aquino MSN, FNP-C. Mark has a Masters of Science in Nursing from West Coast University and is a board certified family nurse practitioner with over 8 years of real world experience in healthcare and currently practicing in urgent care diagnosing and prescribing treatments in California, USA. He is author of the book Physical Assessment for Nurses Simplified.