Acute otitis media tends to be very painful and is often accompanied by symptoms such as fever, listlessness, hearing impairment, irritability, difficulty sleeping, vomiting and diarrhea. Symptoms are typically most severe during the first 24 hours of an infection. Parents may suspect an ear infection if their child’s symptoms appear soon after a cold or allergy flare-up.

Older children may verbalize their symptoms, complaining of an earache or feeling of fullness or pressure in the ear. It can be more challenging for parents of very young children who cannot speak to pinpoint the source of the problem. Often, the cry of an infant experiencing an ear infection will sound distinct compared to the cry that is associated with tiredness or hunger. The response of an infant to a sudden noise may be reduced. Younger children may also pull at or rub their ears, and may not appear to hear as clearly.

Other symptoms associated with otitis media include loss of appetite (anorexia) and dizziness or loss of balance. In some cases, pus resulting from an eardrum infection causes so much pressure on the eardrum that it ruptures. Pus and blood may then drain from the ear. This rupture actually releases pressure, lessening a child’s pain. In most cases, the ruptured eardrum will heal on its own. 

Some cases of ear infection may occur without any noticeable symptoms. This is particularly true of children who have otitis media with effusion (in which fluid builds up in the ear). However, mild or moderate hearing loss may occur in children who have otitis media with effusion. Ear discomfort and behavioral changes may be other indicators of otitis media with effusion.

An ear infection that continues to linger can damage the eardrum, ear bones and structures of the middle ear, leading to hearing loss. Any form of hearing loss in a young child – even short-term, temporary impairment – can lead to delays in language development. This is especially true for children with learning disabilities, or genetic conditions that affect development such as Down syndrome.

External ear infections (swimmer ear) may cause itchiness of the ear and redness and inflammation of the outer part of the ear in addition to other symptoms typically associated with otitis media. Inner ear infections (labyrinthitis) may cause severe dizziness and vomiting in addition to other symptoms typically associated with ear infections. Inner ear infections related to a bacterial infection are particularly likely to cause permanent hearing loss.

However, in most cases, hearing loss associated with ear infections is temporary and clears four to six weeks after the infection is resolved.