How to recognize an ear infection
An ear infection usually announces itself through ear pain, fluid drainage, or hearing changes that come on over hours or a day or two. The pain is often sharp or dull and constant, and it may get worse when you lie down or chew. You might also notice your ear feels full or plugged, or you hear a ringing sound. These signs point to an infection in the middle ear — the space behind your eardrum where fluid normally drains but gets trapped when you have an infection.
Not every ear infection feels the same. Some people have mild discomfort; others have severe pain that wakes them at night. Children sometimes tug at their ears or cry without pointing to a specific spot. Fever often comes with an ear infection, though not always. If you see fluid or pus draining from the ear, that is a sign the eardrum has ruptured from pressure — this actually relieves pain but means you need to see a doctor.
Key Takeaways
- Ear pain that comes on suddenly, especially with fever or hearing changes, is the most common sign of an ear infection.
- Fluid draining from the ear or a feeling of fullness and pressure are other strong indicators that an infection is present.
- A doctor can confirm an ear infection by looking inside your ear with an otoscope, a small lighted instrument.
- Ear infections often follow a cold or sinus infection, so recent congestion or drainage in your nose is a clue.
- Some ear infections clear on their own within a few days, but you should see a doctor if pain is severe, fever is high, or symptoms last more than a few days.
When ear pain means you should see a doctor
Mild ear discomfort that goes away in a day or two may not need a doctor visit. But you should call your doctor or visit an urgent care clinic if the pain is severe, if you have a fever above 100.4°F (38°C), if fluid is draining from your ear, or if your hearing has changed. You should also see a doctor if the pain lasts longer than three days or if you have had multiple ear infections in the past few months.
Children with ear infections should be seen by a doctor more quickly than adults, especially if they are under six months old, have a high fever, or seem very uncomfortable. If your child is pulling at their ear and running a fever, that warrants a same-day call to your pediatrician. Adults who have diabetes or a weakened immune system should also see a doctor sooner rather than waiting to see if the infection clears on its own.
What a doctor looks for during an ear exam
Your doctor will use a tool called an otoscope — a small handheld instrument with a light and a magnifying lens — to look inside your ear canal and at your eardrum. This takes only a minute and does not hurt. The doctor is checking for redness, swelling, fluid behind the eardrum, or a bulging eardrum, all of which point to infection. If the eardrum has ruptured, the doctor will see a hole or opening.
Sometimes your doctor will also use a tool called a pneumatic otoscope, which gently puffs air into the ear canal to test whether the eardrum moves normally. A eardrum that does not move suggests fluid is trapped behind it. Your doctor may also ask about your recent symptoms, whether you have had a cold, and whether you have had ear infections before. This history helps confirm the diagnosis.
Ear infections that follow a cold or sinus problem
Most ear infections develop after a cold, sinus infection, or allergies cause congestion in your nose and throat. The tube that drains fluid from your middle ear — called the Eustachian tube — gets blocked by swelling or mucus. Fluid builds up behind your eardrum, and bacteria or viruses grow in that trapped fluid. This is why ear infections often start a few days after your cold symptoms peak.
If you have had a runny nose, sinus pressure, or a sore throat in the past week, and now you have ear pain, that sequence is a strong clue that an ear infection has developed. Blowing your nose hard, flying in an airplane, or diving underwater can also trigger the Eustachian tube to get blocked, leading to infection. Knowing this connection helps you understand why the infection happened and what to watch for if you get another cold.
Differences between middle ear and outer ear infections
The pain and drainage you feel can come from two different places. A middle ear infection (the most common type) causes pain deep inside your ear, a feeling of fullness, and sometimes fever. The pain often gets worse when you lie down. An outer ear infection, sometimes called swimmer's ear, causes pain when you tug on your earlobe or when water touches the ear canal. The outer ear may also itch, and you might see drainage or redness around the opening of your ear.
Outer ear infections are more common in people who swim frequently or clean their ears aggressively with cotton swabs. Middle ear infections are more common after a cold and are the type most children get. The treatment differs between the two, which is why telling your doctor where the pain is located matters. If you are not sure, describe exactly what hurts — deep inside, at the opening, or all over — and your doctor will figure out which type you have.
What happens if you wait and the infection does not clear
Most ear infections either clear on their own within a week or two or respond well to treatment. But if an infection lingers without treatment, the pressure can damage your eardrum or lead to complications. Rarely, an untreated middle ear infection can spread to the bone behind your ear (a condition called mastoiditis) or to the inner ear, which affects balance and hearing. These complications are uncommon in adults but more serious in young children.
Repeated ear infections — more than three in six months or four in a year — can also cause lasting hearing loss if the eardrum or tiny bones in the middle ear are damaged over time. This is especially important in children, whose hearing is still developing. If you notice that an ear infection is not improving after a week, or if you have had several infections recently, tell your doctor. They may recommend different treatment or refer you to an ear specialist called an otolaryngologist.
Frequently Asked Questions
Can you have an ear infection without pain?
Yes. Some people have fluid behind the eardrum without pain, especially if the infection is mild or developing slowly. You might notice only hearing loss, a feeling of fullness, or ringing in the ear. This is more common in adults than children. If you have these symptoms without pain, a doctor can still see the fluid with an otoscope.
Does earwax buildup feel like an ear infection?
Earwax buildup can cause ear pain, a feeling of fullness, and hearing loss that mimics an infection. But earwax does not usually cause fever or drainage. A doctor can tell the difference by looking inside your ear — earwax is visible and tan or brown, while an infected eardrum is red and swollen. Do not try to remove earwax yourself with cotton swabs, as this can push it deeper or damage your ear canal.
How long does it take to know if an ear infection is getting better?
Pain usually starts to improve within 24 to 48 hours if the infection is being treated or clearing on its own. Hearing and the feeling of fullness may take longer — sometimes a week or two — to return to normal even after the infection is gone. If you feel no improvement after three days, or if pain gets worse, contact your doctor.
Is it safe to fly or swim with an ear infection?
Flying and swimming are not safe during an active ear infection. Changes in air pressure during flight can increase pain and damage an already-stressed eardrum. Water entering the ear during swimming can worsen the infection or introduce new bacteria. Wait until your doctor says the infection is cleared before flying or swimming.
Can allergies cause ear infections?
Allergies do not directly cause ear infections, but they can lead to one. Allergies cause nasal and throat swelling that blocks the Eustachian tube, trapping fluid in the middle ear where bacteria can grow. If you have seasonal allergies and notice ear pain during allergy season, the two may be connected. Treating the allergy can help prevent the infection from developing.