Ear pain may be the first symptom of an ear infection, especially if the ear pain develops during or shortly after a cold.

Moderate to severe ear pain, when other symptoms are present, may indicate an ear infection. Other symptoms may include:

• Swelling, heat, or tenderness around or behind the ear.
• Redness of the ear, ear canal, or skin around or behind the ear.
• Drainage from the ear that does not appear to be earwax.
• Itching of the ear or ear canal.
• Fever.

The ear has several different structures that can become infected.

• Ear pain and fever may indicate a middle ear infection (acute otitis media), especially if cold symptoms, such as a runny or stuffy nose or a cough, have been present for a few days.
• Ear pain may indicate a fluid-filled blister has developed on the eardrum (bulbous myringitis). This may be caused by mycoplasma or other bacteria.
• Itching, a feeling of fullness in the ear, and pain that is worse when you chew, press on the "tag" in front of your ear, or wiggle your earlobe may indicate an infection of the ear canal (otitis externa).
• External structures can become infected (cellulitis) as a result of:
  • An infection on the skin of the external auditory canal.
  • An otitis externa infection.

A middle ear infection can lead to other more serious infections (complications).

• Redness, swelling, pain behind the ear, and fever may indicate an infection of the bone located behind the ear (mastoiditis).
  • This infection is rare and usually occurs 10 to 14 days after an ear infection.
  • The pain increases when pressure is applied to the bone.
• Headache with severe stiff neck, irritability, confusion, and excessive sleepiness may indicate an infection of the lining of the brain (meningitis).
• Severe dizziness (vertigo) and hearing loss may indicate inflammation in the inner ear (labyrinthitis).

It is important to keep in mind that symptoms of an ear infection (such as pain, hearing loss, and dizziness) can occur with other ear problems as well.