What are the symptoms of otitis media (middle ear infection)?

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Last updated: March 22, 2025 • View editorial policy

From the Guidelines

Otitis media symptoms include ear pain, hearing difficulty, and sometimes fever, with the most common sign being ear pain, which can range from mild to severe and may worsen when lying down, as reported in the most recent and highest quality study 1. The symptoms of otitis media can vary depending on the type of infection, but common symptoms include:

  • Ear pain, which can range from mild to severe and may worsen when lying down
  • Hearing difficulty or loss, which can occur as fluid builds up behind the eardrum
  • Fever, which typically ranges from 100-104°F
  • Feeling of fullness in the ear or popping sensations
  • Drainage from the ear, which can indicate a perforated eardrum and appear as yellow or bloody fluid
  • Young children may show less specific symptoms, such as decreased appetite, vomiting, or balance problems These symptoms develop because infection causes inflammation and fluid accumulation in the middle ear space, putting pressure on the eardrum and affecting hearing, as explained in 1. It is essential to note that symptoms usually appear rapidly in acute otitis media but may develop gradually with chronic or serous otitis media, and if these symptoms occur, especially in children, medical evaluation is recommended as some cases require antibiotic treatment, as suggested in 1. The diagnosis of otitis media depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane for acute otitis media and hearing loss for otitis media with effusion, and diagnostic modalities include pneumatic otoscopy, tympanometry, and audiometry, as discussed in 1.

From the Research

Symptoms of Otitis Media

The symptoms of otitis media (middle ear infection) can vary, but common signs include:

  • Ear pain, which may be indicated by rubbing, tugging, or holding the ear 2, 3, 4, 5
  • Fever 2, 3, 6, 4, 5
  • Irritability 2, 3, 6, 4, 5
  • Otorrhea (discharge from the ear) 3, 5
  • Anorexia (loss of appetite) 3
  • Vomiting or lethargy 3
  • Hearing loss 4
  • Short duration of symptoms for acute otitis media (AOM) 6

Specific Symptoms for Different Types of Otitis Media

  • Acute otitis media (AOM) typically presents with symptoms such as fever, otalgia, otorrhoea, or irritability and short duration 6
  • Otitis media with effusion (OME) is often asymptomatic, but may be characterized by accumulation of fluid in the middle ear 6

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Otitis media: diagnosis and treatment.

American family physician, 2013

Research

Otitis Media: Rapid Evidence Review.

American family physician, 2019

Research

Pharmacotherapy of otitis media.

Pharmacotherapy, 1991

Research

Otology: Ear Infections.

FP essentials, 2024

Research

Otitis media: viruses, bacteria, biofilms and vaccines.

The Medical journal of Australia, 2009

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.