DD1 had Grommets put in last month. The surgeon said her ears were so bad it was like a mix of puss and a gluey like substance had filled her ears. She said she would have had multiple ear infections. Not once has DD1 ever actually complained of sore ears, just that the volume had turned down. I had never taken her to the doctors for an ear infection.
So in saying all that, my first thought would be an ear infection. I remember too when I had on a few years ago it was not so much my ear hurting, but more my head so it makes sense to me that a child may not pull at or hold their ear when there is something wrong. Just be generally upset because their head is hurting. Does that make sense?

Hope she is better today.