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Ear Infection While both conditions involve the middle ear, there are important distinctions: Fluid in the ear typically: Develops without significant pain Occurs after a cold or respiratory infection has resolved Causes primarily hearing and pressure symptoms May persist for weeks or months Doesnt always require antibiotics Ear infections typically: Cause moderate to severe ear pain Develop suddenly and intensely May be accompanied by fever Often include infected fluid or pus Typically require antibiotic treatment However, chronic fluid in the ear can increase the risk of developing bacterial infections, so monitoring the condition is essential