What does hearing loss feel like with a middle ear infection?

A middle ear infection can cause inflammation and fluid behind the eardrum. This may make sounds quieter, duller, or less distinct, as though the ear is plugged. Children may turn up the volume, misunderstand speech, or seem less responsive. Earache, fever, irritability, pressure, and a recent cold can occur alongside the hearing change. The hearing effect often improves as the fluid and inflammation settle, but fluid can remain after pain has eased. Hearing loss can have other causes, so the ear needs an examination when symptoms are persistent, severe, or unusual.

Book an appointment if ear pain, fever, discharge, or reduced hearing continues. Keep the ear dry if discharge is present and do not insert cotton buds, fingers, or drops unless a clinician recommends them. Encourage fluids and use only age-appropriate pain relief according to the label or medical advice. Note which ear is affected and whether hearing changes after the pain improves.

Seek urgent advice for swelling or redness behind the ear, severe worsening pain, marked drowsiness, repeated vomiting, a stiff neck, facial weakness, or sudden hearing loss. Prompt care is also needed for a very unwell child, persistent high fever, or fluid or blood coming from the ear.

Is there fluid behind the eardrum? Is the eardrum intact? When should hearing be checked again? What signs would mean the infection is worsening?