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Middle Ear Infection Symptoms – Signs to Recognize

Middle ear infection typically causes ear pain, a feeling of pressure in the ear, and reduced hearing. It is especially common in children.

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Middle ear infection typically causes ear pain, a feeling of pressure in the ear, and reduced hearing. It is especially common in children.

What Is a Middle Ear Infection?

A middle ear infection (medically known as otitis media) is an inflammation of the middle ear, the space located just behind the eardrum. It is one of the most common illnesses in childhood but can also affect adults. The infection is usually caused by bacteria or viruses, often following a cold or upper respiratory tract infection.

Symptoms of a Middle Ear Infection

Symptoms can vary depending on the severity and type of infection. The most common complaints include:

Pain and Pressure

Ear pain: A sharp or throbbing pain in the affected ear is the hallmark symptom of acute otitis media.
Feeling of pressure: Many patients describe an uncomfortable sense of fullness or pressure in the ear.
Radiating pain: The pain may spread to the jaw, neck, or head.

Hearing Loss and Ear Noises

Reduced hearing: Inflammation and fluid buildup in the middle ear can temporarily impair hearing.
Tinnitus: Some people notice ringing, buzzing, or humming sounds in the ear.

General Illness Symptoms

Fever: Fever is especially common in children and can sometimes exceed 39 degrees Celsius.
General malaise: Fatigue, weakness, and loss of appetite may accompany the infection.
Sleep disturbances: Pain can significantly interfere with sleep.

Signs in Infants and Toddlers

Infants and young children cannot verbally communicate their discomfort. The following signs may indicate a middle ear infection:

Frequent tugging or rubbing of the ear
Unusual irritability and crying
Sleep difficulties and restlessness
Feeding problems or loss of appetite
Unexplained fever

Purulent Ear Discharge

If pus builds up in the middle ear and causes the eardrum to rupture under pressure, purulent discharge may drain from the ear. In this case, the pain often subsides suddenly as the pressure is relieved. Ear discharge is a clear sign that medical attention is required.

Types of Middle Ear Infection

There are several forms, each presenting slightly differently:

Acute otitis media: Starts suddenly with intense ear pain, fever, and hearing loss.
Chronic otitis media: Persists for weeks or months, often with less pronounced pain but ongoing hearing loss and recurrent discharge.
Otitis media with effusion (glue ear): Fluid accumulates in the middle ear without typical signs of infection such as fever. Common in children.

Causes and Risk Factors

Middle ear infections often develop as a complication of a cold or upper respiratory infection. Through the Eustachian tube, which connects the middle ear to the back of the nose and throat, pathogens can reach the middle ear. Risk factors include:

Frequent colds or upper respiratory infections
Enlarged adenoids
Exposure to secondhand smoke
Attendance at daycare or close contact with other children
Breastfeeding supports the immune system and may reduce the risk

Diagnosis

A doctor diagnoses a middle ear infection based on reported symptoms and a physical ear examination (otoscopy). Using an otoscope, the eardrum is examined for redness, bulging, or fluid behind it. If needed, a hearing test (pure-tone audiometry) or tympanometry may be performed to assess middle ear function.

Treatment

Treatment depends on the cause and severity of the infection:

Pain relief: Over-the-counter pain relievers and fever reducers such as ibuprofen or paracetamol can ease symptoms.
Decongestant nasal drops: These help improve ventilation of the middle ear through the Eustachian tube.
Antibiotics: Required in cases of bacterial infection or severe illness.
Watchful waiting: In uncomplicated cases, many infections resolve on their own without antibiotics.
Ear tubes (grommets): In chronic or recurrent cases, a minor surgical procedure to insert small ventilation tubes may be recommended.

When to See a Doctor

The following signs require prompt medical evaluation:

Severe or persistent ear pain
High fever, especially in young children
Discharge from the ear
Persistent or significant hearing loss
Dizziness or balance problems
Stiff neck or severe headache (possible sign of a complication)

References

Deutsche Gesellschaft fur Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V. (DGHNO-KHC): Guideline on Acute Otitis Media. AWMF Register No. 017/004 (2020).
World Health Organization (WHO): Chronic suppurative otitis media. WHO/PDH/98.4. Geneva, 1998.
Lieberthal A.S. et al.: The Diagnosis and Management of Acute Otitis Media. Pediatrics, 131(3):e964-e999 (2013).

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