The diagnosis is made by the combination of symptoms and examination of the tympanic membrane for redness, bulging, and/or a middle ear effusion (collection of fluid within the middle ear).Complications of otitis media include hearing loss, facial nerve paralysis, or extension of infection to surrounding anatomic structures, including:
Mastoiditis: infection of the air cells in the mastoid process, the area of the skull located right behind the ear
Petrositis: infection of the petrous portion of the temporal bone
Labyrinthitis
Meningitis
Subdural abscess
Brain abscess
Cerebral venous sinus thrombosis

Trauma
Barotrauma: results from changes in atmospheric pressure that occur when descending in a plane or deep diving. As atmospheric pressure increases with descent, the eustachian tube collapses due to pressure within the middle ear being less than the external pressure, which causes pain. In severe cases, middle ear hemorrhage or tympanic membrane rupture can result. Tympanic membrane rupture: disruption of the eardrum. This can be caused by a blow to the ear, blast injury, barotrauma, or direct penetration of the tympanic membrane by an object entering the ear. Referred ear pain
A variety of conditions can cause irritation of one of the nerves that provides sensation to the ear. Conditions causing irritation the trigeminal nerve (cranial nerve V):
Temporomandibular joint syndrome: inflammation or abnormal movements of the joint between the jaw and skull. These disorders are most common in women of childbearing age, and are uncommon in children younger than 10 years old. Myofascial pain syndrome: pain in the muscles involved in chewing.
For symptoms that are not responsive to treatment within 10 days, a physician should evaluate for necrotizing external otitis. Acute otitis media (AOM) self-resolves within 24–48 hours in 80% of cases. If it does not self-resolve, AOM thought to be caused by bacteria is treated with systemic antibiotics. If symptoms do not respond to a week of treatment, a physician should evaluate for mastoiditis. Acute folliculitis. Auricular cellulitis. Suppurative otitis media. There is also a risk for tympanic membrane rupture. Perichondritis. An otorhinolaryngologist should also evaluate it and if a foreign body is present in the cartilage, this foreign body should be removed. If there is cartilage involvement, then more advance care with hospitalization is needed. Sinusitis can cause secondary ear pain. Treating the underlying sinusitis will treat the ear pain. (See sinusitis. )Some bacterial infections may require a more advanced treatment with evaluation by otorhinolaryngology, IV antibiotics, and hospital admission. Necrotizing external otitis is potentially fatal and should be evaluated by an otorhinolaryngologist with admission to the hospital and IV antibiotics. (See otitis externa.) Acute mastoiditis is treated with admission to the hospital, otorhinolaryngology consultation and empiric IV antibiotics. Cases with intracranial involvement are treated with a mastoidectomy with myringotomy. Chondritis. Procedures
Some causes of ear pain require procedural management alone, by a health professional, or in addition to antibiotic therapy. Keratosis obturans is treated with removal of impacted desquamated keratin debris in the ear canal. Chronic perichondritis and chondritis that continues to be symptomatic despite appropriate antibiotic management may require surgical debridement.