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What Are the Signs of an Ear Infection?

irritable man with ear infection

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  • If you have a middle ear infection, symptoms may suddenly develop, with pain or discomfort being the most common
  • An inner ear infection, which is more of inflammation and not an actual infection, can be indicated by ear pain, nausea or vomiting, as well as earache, fullness in the ear and problems linked to walking, hearing or balancing

Symptoms of ear infections vary among patients, and some signs may indicate the type of ear infection that a person has developed.

Typical Middle Ear Infection Symptoms to Watch Out For

If you have a middle ear infection, symptoms may suddenly develop, with pain or discomfort being the most common. Other indicators are:1

  • Ear pain
  • Slight hearing loss
  • Fever
  • Irritability
  • Sleeplessness
  • Appetite loss

Middle ear infections can be particularly challenging for parents, especially if their child hasn't learned how to speak yet and may not be able to communicate exactly what they're feeling.

Some children may show ear infection-related pain if they have difficulty swallowing their food. Another possible sign of ear infection in children is when they tug on their ear, although this may be linked to teething-caused pain as well. Parents may also find it difficult to see if a child has an ear infection if they have fevers and colds, since these illnesses typically make children irritable and fussy.

Should parents notice pus draining from the ear, it may indicate a severe ear infection that has triggered a rupture in the tympanic membrane in the ear. Pus is considered a red flag as it may lead to hearing loss in some children.3

How Do You Know if You Have Otitis Media With Effusion?

An otitis media with effusion, or a buildup of fluid in the middle ear,4 may not produce symptoms at all. Hearing loss can occur at some point, but it may fluctuate and be hard to detect. Common indicators of OME among children are complaints of "plugged up" hearing, loud talking, failure to respond to verbal commands and a tendency to increase the volume of the television or radio.

A sense of fullness in the ear may also be felt by older children and adults with OME. In some instances, older children with OME have difficulty locating or targeting specific sounds in noisy rooms. However, such behaviors can also be linked to lack of attention or even to attention deficit hyperactivity disorder (ADHD).5

Detecting Inner and Outer Ear Infections

An inner ear infection, which is closer to inflammation and not an actual infection, can be indicated by ear pain, nausea or vomiting, as well as earache and fullness in the ear, or walking, balance or hearing problems.6 However, in some cases inner ear infections or pain can also be a symptom of a more serious condition like meningitis.7,8 Meanwhile, an outer ear infection, or otitis externa, typically starts as an itchy rash that may cause the ear to become painful, tender, red and swollen.9

Common Symptoms of a Fungal Ear Infection

If you or someone you know has otomycosis, or an ear infection caused by fungi, take note of these indicators:10

  • Pain
  • Inflammation
  • Redness on outer ear
  • Ringing in the ears
  • Hearing problems
  • Itching
  • Swelling
  • Flaky skin
  • Feeling of fullness in the ears
  • Discharge of fluid from the ears that may be white, yellow, black, grey or green
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Ear Infection Symptoms in Adults

Although children are more vulnerable to ear infections, adults may be affected by middle and outer ear infections too. Inner ear infections, although they're less frequent, can sometimes indicate an underlying medical condition. Medical News Today lists the common indicators of ear infections in adults:

  • Inflammation and pain
  • Hearing changes
  • Vomiting
  • Fever
  • Swelling of the ear
  • Tenderness to the touch
  • Nausea
  • Dizziness
  • Headaches
  • General tiredness

An inflamed eardrum can trigger hearing troubles in some adults because its sensitivity toward sound is weakened. If there's fluid or pus buildup behind the eardrum, difficulty hearing is increased and may give a person a feeling of being underwater.

In some cases, patients may notice fluid seeping out of the ear, and this is mainly caused by the eardrum tearing or bursting because of pressure caused by the infection. This is a red flag, since ear discharge may indicate a more serious medical issue that should be addressed and diagnosed by a doctor immediately.

Adults with outer ear infections also experience an itchy rash on the outside of the ear, and have an ear or ear canal that tends to become red, and feels painful, swollen, tender and warm until the infection goes away.11

How Are Ear Infections Diagnosed?

When diagnosing ear infections among children, doctors will first ask parents if the child recently experienced a cold or sore throat, or has exhibited symptoms of this disorder.12 The doctor must rule out other causes of ear pain if the child complains of pain or shows other signs of a middle ear infection, such as redness and inflammation. Normally, doctors have three criteria that may help them diagnose a middle ear infection, namely:13

  • A history of recent and sudden symptoms
  • Presence of fluid in the middle ear or an effusion
  • Symptoms of inflammation

Potential patients may also undergo physical examinations to fully diagnose ear infections. Ear examinations are critical in physical exams, especially in children, since infections are common and may not trigger symptoms. Doctors may first remove ear wax or cerumen to get a clear view of the middle ear, followed by inspection with these devices:

  • Otoscope — This is a lighted instrument that doctors (or even parents, provided that they have been guided properly) can use to inspect a child's ear and look for common ear infection symptoms.14
  • Pneumatic otoscope15 It can identify an ear infection and help detect a decrease in eardrum motion. The otoscope pushes air into the ear, and the doctor observes how the air acts against the eardrum. This helps identify eardrum movement.16

Other procedures used to check for ear infections include:17

  • Tympanometry — A small probe is held at the entryway of the ear canal to develop an airtight seal. This probe can alter air pressure in the ear and prompt the eardrum to move back and forth. A sound with a fixed tone is then directed toward the eardrum so its energy is measured, and a machine records results on graphs called tympanograms.18
  • Reflectometry — This procedure measures reflected sound. While a reflectometry may inspect for fluid and obstruction, it doesn't involve the application of an airtight seal at the canal.

However, take note that both procedures aren't substitutes for the pneumatic otoscope, as the latter allows the doctor to directly view the middle portion of the ear.

A tympanocentesis may be required too, albeit only on severe or recurrent cases. In this procedure, an ear, nose and throat (ENT) specialist uses a needle to draw out fluid from the ear to check for specific bacteria. In most ear infection cases, this procedure isn't required to fully determine an accurate enough diagnosis for treatment.19

Can an Ear Infection Be Diagnosed at Home?

Sonar-like devices such as the EarCheck Monitor may be used by parents to look for fluid in a child's middle ear. The device utilizes acoustic reflectometry technology, and involves "bouncing" soundwaves off the eardrums to check for eardrum mobility. Fluid trapped behind the middle ear can cause the eardrum to be less mobile. A device like this can work similarly to an ear thermometer and is painless.

Results from the device can show the presence of fluid in the ears and assist parents in determining if they need to talk to a doctor. However, it's advised to avoid implementing treatment protocols, especially those that involve antibiotics, solely based on findings from this device. Consulting a doctor to know the best remedies for a particular case of ear infection is still ideal.20


Ear Infection: An Introduction

What Is an Ear Infection?

Ear Infection Symptoms

Ear Infection Causes

Types of Ear Infection

Ear Infection in Babies and Children

Are Ear Infections Contagious?

Ear Infection Treatment

Essential Oils for Ear Infection

Ear Infection Prevention

Ear Infection FAQ

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