Ear Infection Symptoms in Adults: How to Tell

What are the two main types of ear infections in adults?

Outer ear infection (otitis externa / swimmer’s ear): This affects the ear canal — the tube between the outer ear and the eardrum. It is typically caused by bacterial growth in a warm, moist environment (after swimming, prolonged water exposure, or scratching the canal with a cotton swab). Pain is often the dominant symptom and is characteristically worse when you gently pull the earlobe or press the small bump in front of the ear canal (the tragus). The canal may feel itchy, and there can be discharge 1Ref 1Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, Huang WW, Haskell HW, Robertson PJ (2014).Clinical Practice Guideline: Acute Otitis Externa.Diagnosis and topical antibiotic treatment of acute otitis externa (swimmer’s ear); recommendations against oral antibiotics for uncomplicated outer ear infections.

Middle ear infection (otitis media): This occurs behind the eardrum in the middle ear space. It usually follows a cold or upper respiratory tract infection when bacteria or viruses ascend through the eustachian tube. The eardrum can become inflamed and fluid may accumulate 2Ref 2Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, et al. (2016).Clinical Practice Guideline: Otitis Media with Effusion (Update).Background on middle ear fluid and effusion as a component of ear infection management; watchful waiting principles for otitis media. Symptoms include deep ear ache, a sense of fullness or pressure, muffled hearing, and sometimes fever 3Ref 3National Library of Medicine (2025).Ear Infections | Otitis Media.Overview of ear infection types, symptoms, and when to seek care; otitis media is the most common cause of ear infections across age groups.

What does an ear infection feel like in adults?

Symptoms vary by type, but several patterns are common:

Outer ear infection: - Itching inside the ear canal, sometimes before pain develops - Pain ranging from mild to severe, especially when chewing or when the ear is touched - Discharge that may be clear, white, or slightly yellow - A feeling that the ear canal is swollen or partially blocked - Muffled hearing if swelling narrows the canal significantly

Middle ear infection: - Deep, throbbing or aching pain - A sense of pressure or fullness behind the eardrum - Muffled hearing on the affected side - Possible fever (though fever is less common in adults than in children) - Occasionally, fluid draining from the ear if the eardrum develops a small perforation — this often actually relieves the pain

The location of the pain is one useful clue: outer ear infections hurt when the ear is touched or moved; middle ear infections ache from within and are not made worse by pulling the earlobe.

How common are ear infections in adults?

Ear infections are far more frequent in children than in adults. Children have shorter, more horizontally oriented eustachian tubes, which makes middle ear infections much easier to acquire. Adults who do develop middle ear infections often have an identifiable trigger: a recent respiratory illness, allergy flare, eustachian tube dysfunction, or, in the case of outer ear infections, water exposure or mechanical irritation of the canal.

Certain adults are at higher risk for outer ear infections: regular swimmers, people who use hearing aids or earbuds frequently, and those who clean their ears aggressively with cotton swabs (which can remove the natural cerumen barrier and micro-abrade the canal lining).

Do I need antibiotics for an ear infection?

For outer ear infections, topical antibiotic ear drops (often combined with a mild corticosteroid to reduce swelling) are effective and typically the primary treatment 1Ref 1Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA, Huang WW, Haskell HW, Robertson PJ (2014).Clinical Practice Guideline: Acute Otitis Externa.Diagnosis and topical antibiotic treatment of acute otitis externa (swimmer’s ear); recommendations against oral antibiotics for uncomplicated outer ear infections. Oral antibiotics are usually not necessary for uncomplicated outer ear infections.

For middle ear infections in adults, current clinical practice generally supports a period of watchful waiting of 48 to 72 hours before starting antibiotics, because many cases resolve on their own — particularly when caused by a virus 2Ref 2Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, et al. (2016).Clinical Practice Guideline: Otitis Media with Effusion (Update).Background on middle ear fluid and effusion as a component of ear infection management; watchful waiting principles for otitis media. Antibiotics are appropriate sooner when symptoms are severe, when there is high fever, or when the person is immunocompromised.

A clinician must examine the ear to distinguish an outer from a middle ear infection and to determine whether antibiotics are warranted. Self-treating with leftover antibiotics or ear drops prescribed for another person is not advisable — the wrong treatment for the wrong type of infection can delay recovery.

What causes pain in the ear that is not an infection?

Ear pain without an infection is common and is called referred otalgia — pain originating elsewhere that is felt in the ear because many nerves serving the jaw, teeth, throat, and neck also supply sensation to the ear. Common non-infectious causes include:

• Temporomandibular joint (TMJ) problems: jaw joint pain felt near or in the ear, often with clicking
• Dental problems: a tooth abscess or impacted wisdom tooth can present as ear pain
• Throat conditions: tonsillitis or throat infections can radiate pain to the ear
• Eustachian tube dysfunction: pressure and discomfort without an active infection
• Cerumen impaction: earwax pressing on the eardrum can cause pain

If ear pain is persistent and a clinician looks inside and finds a normal ear canal and eardrum, one of these alternative causes is likely, and investigation of the jaw, teeth, or throat is appropriate.

When should I see a clinician for ear pain or an ear infection?

A primary care appointment is appropriate when:

• Pain is significant or getting worse rather than better after 24 to 48 hours
• You have fever alongside the ear pain
• There is discharge or fluid draining from the ear
• Hearing seems substantially reduced
• Ear pain is accompanied by dizziness or balance problems
• You are immunocompromised, have diabetes, or have other conditions that raise infection risk

Gale's primary care clinicians can examine your ear, distinguish the type of infection, and prescribe appropriate treatment. Most ear infections do not require an ENT specialist visit, though recurrent middle ear infections or persistent otitis media with effusion may warrant referral.