Is Your Earache Just a Cold or an Ear Infection?

Got an earache? How do you know if your earache is from a cold or an ear infection called otitis media? Here's how to tell the difference.

An earache from a cold can be a sharp, dull, or burning pain that can range from mild to very painful. Even if the trapped fluid in the ear is not infected, the fluid puts pressure on the eardrum, causing it to bulge and throb. With an earache from a cold, you or your child may have difficulty sleeping, run a fever, and have green or yellow mucus in the nose. Because colds are self-limiting, an earache with a cold usually goes away on its own. Still, if you have an earache, an ear infection may be likely, which means you might need to see your doctor for a diagnosis and proper treatment.

While earaches can occur first with a cold virus, sometimes a secondary ear infection may occur. These ear infections are usually sudden in onset and extremely painful in the beginning. That's because the sensory nerve endings in the eardrum respond to increased pressure with pain. After the eardrum stretches a little, the earache pain may ease up.

Other symptoms of an earache from an ear infection may include the following:

• Loss of appetite. This may be apparent in young children, especially during bottle feedings. Pressure changes in the middle ear as the child swallows, causing more pain.
• Irritability.
• Poor sleep. Pain may be more persistent when lying down as fluid is shifting.
• Fever. Ear infections can cause temperatures up to 104 degrees F.
• Vertigo. You may have a sense of spinning.
• Drainage from the ear. Yellow, brown, or white fluid that isn't earwax may seep from the ear, indicating the eardrum has ruptured.
• Difficulty hearing. Fluid build-up in the middle ear prevents the eardrum from functioning properly. The sound is then unable to be transmitted to the bones of the middle ear and from there to the brain.
• Otitis media with effusion. Symptoms of acute otitis media will disappear, but the fluid, which is called an effusion, may remain. Trapped fluid causes temporary and mild hearing loss.

How Is an Ear Infection Diagnosed?

When your doctor suspects an ear infection, he or she will examine the ear using an instrument called an otoscope. A healthy eardrum is pinkish gray in color and transparent. If an ear infection is present, the eardrum may be inflamed, swollen, or red. The doctor may also check the fluid in the middle ear using a pneumatic otoscope. This instrument blows a small amount of air at the eardrum, causing the eardrum to move back and forth. The eardrum will not move as readily if fluid is present inside the ear.

Another useful diagnostic tool for ear infections is tympanometry. This is a test that uses sound and air pressure to check for fluid in the middle ear (it cannot test hearing).

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