10 Signs of an Ear Infection (Outer, Middle and Inner Ear)

Ear infections are common, especially in children. It can affect the outer ear (otitis externa), middle ear (otitis media) or inner ear (otitis interna). The signs and symptoms of an ear infection can vary somewhat depending on which part of the ear is infected. Sometimes complications may arise which may further contribute to the overall symptoms.

How Do The Ears Become Infected?

Most infections of the ear are caused by bacteria and viruses but sometimes fungi may also be responsible. Otitis externa and otitis media are the most common. Sometimes these infections can become serious. Otitis interna is uncommon and is usually serious, often associated with life-threatening conditions like meningitis.

Outer Ear Infections

Most outer ear infections are caused by a disturbance in the ear canal. This is frequently seen with water accumulation in the ear that allows for bacteria to thrive in the outer ear. It is therefore also called swimmer’s ear. Another common contributing factor is excessive cleaning of the ear. Too little earwax, injury to the outer ear and allergic reactions increases the risk of infections.

Read more on outer ear infection.

Middle Ear Infections

Infections of the middle ear are usually linked to upper respiratory tract infections like the common cold (viral). The eustachian tube that connects the middle ear to the back of the nose allows viruses and bacteria to enter the middle ear. Bacterial infections can persist if eustachian tube is blocked and fluid within it cannot drain out. Apart from eustachian tube abnormalities, allergies can also play a role.

Read more on middle ear infection.

Inner Ear Infections

Infections of the inner ear may be due to viruses or bacteria. Viral infections may spread from upper respiratory tract infections, like the common cold or influenza. Bacterial infections of the inner ear arise when bacteria spread from neighboring sites. It usually follows middle ear infection (otitis media), meningitis or mastoiditis.

Read more on inner ear infection.

What Does An Ear Infection Look Like?

Although the main signs and symptoms of ear infections may appear similar, there are some distinct differences in symptoms between otitis externa, media and interna. Symptoms may also vary between children and adults. Infants and toddlers may display symptoms that are otherwise unseen in older children and adults.

Ear Pain

Ear pain or an earache is one of the most common symptoms of outer, middle and inner ear infections. However, it is not always present. Sometimes there may be no sensation in mild cases or other sensations like pressure or itching.

When present, the nature and intensity of the pain can vary. Milder cases may present with a dull ache but the intensity of the pain is not always a clear indication of the severity of the infection. The pain may be described as stabbing, sharp or a bursting pain.

Itchy Ear

Itching of the ear is another common sign of an ear infection, particularly of an outer ear infection but can also occur with a middle ear infection. The itching in the ear canal can sometimes be the only sign of otitis externa and may persist for long periods with little to no other symptoms. This is more likely to occur with fungal otitis externa. At other times, otitis externa may present with a severely itchy rash which is also visible on the outside of the ear.

Redness and Swelling

Redness and swelling are signs of inflammation. It is more apparent in the external ear, including the outer part (pinna) and the ear canal. There may also be redness and swelling of the eardrum in otitis externa (outer ear infection) and otitis media (middle ear infection). With otitis media in particular there may also be bulging of the eardrum. However, many of these eardrum signs may only be visible with an otoscope.

Ear Discharge

A discharge from the ear is another symptom that may be seen in ear infections. It is more likely to occur with outer and middle ear infections. The discharge may vary from clear serous fluid, to pus and blood. Sometimes the discharge may be thick, sticky and have an offensive odor but is mistaken for earwax. Another possible fluid discharge from the ear is cerebrospinal fluid (CSF) when there is a rupture in the bone that separates the cranial cavity and ear.


A fever is usually a sign of an infection and may occur with middle or inner ear infections and advanced cases of outer ear infections. Fevers due to ear infections are more likely to occur in children. Sometimes the fever may be due to underlying conditions like the flu or meningitis with an ear infection arising secondary.

Diminished Hearing

Hearing may be affected to varying levels in outer, middle and inner ear infections. Sounds may appear muffled or hearing may appear to be better in one ear compared to the other. Infants may be less responsive to sounds and voices than normal. There may even be a total loss of hearing, usually in one ear, in severe or prolonged ear infections particularly when treatment is delayed.

Poor Balance and Dizziness

Disturbances in balance are more likely to occur with middle and inner ear infections. Toddlers may appear “clumsy” due to repeated falling or hitting walls when walking. Dizziness is a common sign of an inner ear infection but may also occur with middle ear infections. There may also be reports of vertigo. However, other causes of these symptoms should not be ignored as some of these causes can be very serious.

Other Signs and Symptoms

A host of other signs and symptoms may be present that are usually non-specific for an ear infection. These symptoms should therefore be considered along with one or more of the other symptoms mentioned above.

  • Headaches
  • Nausea
  • Vomiting
  • Loss of appetite
  • Difficulty sleeping
  • Irritability and restlessness (children)
  • Tugging or picking the ear (children)

It is important to note that serious and potentially life-threatening conditions like meningitis may present with many similar symptoms. Always seek medical attention for even minor symptoms of an ear infection. Early diagnosis and prompt treatment can prevent complications.

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