Ear Infection Symptoms: Middle, Inner, or Outer Ear Pain

The symptoms of an ear infection vary by whether the infection is in the outer ear (otitis externa), middle ear (otitis media), or inner ear (otitis interna). Each type affects different organs involved in hearing. Though ear pain is a common symptom. Other signs and symptoms can include hearing loss, vertigo, a loss of balance, ringing in the ears, and fluid discharge from the ear canal.

This article describes the different signs and symptoms of an ear infection in adults and children, including how ear infections happen and when it is time to see a healthcare provider.

Ear Infection Symptoms: Do I Have Ear Inflammation?

Ear infections are commonly caused by bacteria, viruses, and occasionally fungi or parasites. As it does with all infections, the immune system will respond to an ear infection by producing inflammation.

Inflammation is a defensive response that causes the dilation (widening) of blood vessels to allow immune cells closer access to the site of the infection. This, in turn, generates heat, pain, and swelling of tissues.

Depending on which organs of the ear are affected, an ear infection can cause a cascade of different signs and symptoms, both common and uncommon.

Symptoms of an Outer Ear Infection

Otitis externa is the inflammation of the ear canal which runs from your eardrum to the outside of your head. It is often called swimmer's ear because it frequently affects people who get bacteria or fungi in their ears from swimming in polluted water.

Swimmer's ear can also occur if your ear gets routinely blocked with water. oversaturating the skin and causing breaks that allow bacteria to enter underlying tissues. Putting cotton swabs or other objects into your ear is a common way to introduce bacteria into the ear canal.

Swimmer's ear is common in children and young adults but can affect people of any age.

An outer ear infection can progress if not properly treated. Symptoms vary by the severity of the infection, as shown in the following table.

Symptoms of a Middle Ear Infection

Otitis media is inflammation of the middle ear situated just behind the eardrum. It is comprised of three bones called the ossicles. These bones transmit sounds as vibrations to the inner ear and the eustachian tube, the tube connecting to the upper throat that equalizes pressure in the middle ear.

Otitis media most often occurs when an upper respiratory tract infection triggers inflammation of the eustachian tube and the blockage of fluids in the middle ear. Bacteria and viruses can both cause a middle ear infection. Children are affected far more than adults.

Symptoms of otitis media vary by whether it is acute (sudden and short-lasting) or chronic (persistent or recurrent).

The three types of middle ear infections, which vary by their severity, are:

• Acute otitis media (AOM): The infection and inflammation of the middle ear
• Otitis media with effusion (OME): AOM with the buildup of noninfected fluid in the middle ear
  
• Chronic suppurative otitis media (CSOM): An ongoing inner ear infection with persistent drainage lasting for more than two to six weeks
  

Symptoms can differ based on the infection type.

Symptoms of an Inner Ear Infection

Otitis interna is the inflammation of the central chamber of the inner ear (labyrinth) and/or the nerve that transmits signals from the inner ear to the brain (vestibulocochlear nerve). In addition to translating sound vibrations into nerve impulses, these structures help you maintain balance by constantly relaying information to the brain about the orientation of your head in space.

When the infection affects the labyrinth and vestibulocochlear nerve, it is called labyrinthitis. When only the vestibulocochlear nerve is affected, it is called vestibular neuritis.

Labyrinthitis is most often caused by a virus or bacterium, but there are also noninfectious causes like allergies, cholesteatoma (a benign growth in the ear), and certain medications. Vestibular neuritis is most often seen in people with shingles (herpes zoster virus).

Otitis interna is more common in adults, the symptoms of which vary by the extent of the inner ear involvement.

How Do You Spot Ear Infection Symptoms in Children?

Acute otitis media is the most common diagnosis worldwide. Children are affected more than adults, with 70% experiencing at least one episode before the age of 2. This is due in part to the horizontal position of the eustachian tube in babies and toddlers, which collects fluids more easily, as well as the lack of a mature immune system.

Some young children have as many as five or six episodes per year.

Because children of this age usually cannot express what they are feeling, it is important to recognize the signs and symptoms of AOM if they are not old enough to tell you their ear hurts.

Signs and symptoms of an ear infection in babies and toddlers include:

• Tugging or pulling at an ear
• Fussiness, irritability, and crying
• Trouble sleeping
• Fever
  
• Fluid drainage from the ear
• Clumsiness or balance problems
• Trouble hearing or being nonresponsive to quiet sounds
  

When to Get Medical Help for Severe Ear Infection Symptoms 

Ear infections may seem commonplace, but some people are at greater risk of complications than others. These include children whose hearing organs (including the ossicles and cochlea) are delicate and vulnerable to irreversible damage from a severe ear infection.

Certain vulnerable adults can also experience severe complications of an ear infection, including a ruptured eardrum, permanent hearing loss, and the spread of infection to the face, skull, and brain (causing facial paralysis, meningitis, mastoiditis, and brain abscesses).

For children, the Centers for Disease Control and Prevention (CDC) recommends seeing a healthcare provider immediately if your child has:

• A fever of 102.2 degrees F or higher (or 100.4 degrees F in infants under 3 months)
• Symptoms of a middle ear infection lasting more than one or two days
• Pus or fluid discharge from the ear
• Worsening symptoms
• Hearing loss
• Any other symptoms you find concerning

For adults, it is important to see a healthcare provider if you have:

• High fever
• Symptoms of a middle ear infection lasting more than two to three days
• Severe pain and swelling behind the ear
• Pus or fluid discharge from the ear
• Hearing loss
• Facial weakness or drooping
• Double vision or a sudden aversion to light
• Neck stiffness
• Any other symptoms you find concerning

How Long Ear Infection Symptoms Last

Some ear infections can heal on their own and resolve within a few days. Others almost invariably require medical treatment and may take weeks to fully clear.

Outer Ear Infection

Swimmer's ear generally doesn't go away on its own. It usually requires the cleaning of your ear canal by a healthcare provider and prescription ear drops to kill the bacterium or fungus and/or alleviate inflammation.

Treatment is typically prescribed for seven to 10 days. If left untreated, the condition can persist for months and cause damage to the surrounding bone and cartilage as well as nerves of the brain and face.

Middle Ear Infection

Mild cases of otitis media often clear on their own within three to five days, particularly if caused by an upper respiratory virus. Supportive care may be needed to reduce pain and fever.

Bacterial causes may require antibiotics. When treated, ear infections usually resolve within a few days. However, there may be residual fluid trapped behind the eardrum that can take three to six weeks to fully clear.

Antibiotics can usually clear a bacterial ear infection within five to seven days. The drugs are typically prescribed if the infection doesn't improve on its own within 24 to 48 hours due to the risk of hearing loss.

Treatment is considered essential given that otitis media with effusion is the number one cause of acquired hearing loss in kids.

Inner Ear Infection

The treatment of an inner ear infection varies by the cause. Many cases clear on their own without treatment, often within a few weeks but sometimes longer. During this time, medications like Compazine (prochlorperazine) may be prescribed if vertigo is affecting your ability to function.

Other people may require immediate medical care, including those whose symptoms are caused by bacterial meningitis. This condition, characterized by the swelling of the lining of the brain and spinal cord, is a medical emergency that can progress quickly and lead to shock death if not treated appropriately.

Summary

The symptoms of an ear infection vary by whether the infection is in the outer ear, middle ear, or inner ear. Pain, muffled hearing, and fluid drainage are common with all ear infections. Others, like tinnitus, vertigo, hearing loss, and changes in vision, are the primary symptoms of an inner ear infection or signs that an outer or inner infection is worsening.

To avoid severe complications, see a healthcare provider immediately if an ear infection persists, worsens, or is accompanied by high fever, hearing loss, a pus-like discharge, or any other concerning symptoms.