Knowledge Centre
Providing rapid medical guidance and expert health insights for informational purposes. While our guides are written by Harley Street clinicians, they do not replace a professional consultation.
Ear Infections: Symptoms and Relief
Ear infections are among the most common reasons people visit a GP, particularly for children. They fall into two main types: otitis media (middle ear infection, behind the eardrum) and otitis externa (outer ear infection, in the ear canal). Both cause significant pain, but the treatment approach differs.
Most ear infections clear up on their own within a few days. Knowing when to manage symptoms at home and when to see a doctor prevents unnecessary antibiotic use while ensuring serious cases get treated promptly.
See a doctor urgently if:
- Swelling, redness, or tenderness behind the ear (possible mastoiditis)
- High fever (above 39°C) that doesn't respond to paracetamol
- Sudden hearing loss
- Discharge that is bloody or foul-smelling
- Facial drooping on the same side as the ear pain
- Severe headache, neck stiffness, or confusion alongside ear infection
Mastoiditis (infection spreading to the bone behind the ear) is rare but serious. Swelling and redness behind the ear with a protruding ear lobe warrants same-day medical assessment.
Middle ear infections (otitis media)
Otitis media typically follows a cold or upper respiratory infection. Mucus and inflammation block the Eustachian tube, trapping fluid behind the eardrum. Bacteria or viruses then multiply in the trapped fluid.
Symptoms include earache (young children may pull at their ear), reduced hearing on the affected side, fever, and feeling generally unwell. In children, irritability, poor feeding, and disturbed sleep are common. Sometimes the pressure causes the eardrum to perforate, releasing fluid or pus — this actually reduces pain and usually heals within a few weeks.
NICE recommends pain management with paracetamol or ibuprofen as the first step. Around 80% of middle ear infections resolve within three days without antibiotics. For children under 2, or if symptoms worsen after 48 hours, antibiotics (typically amoxicillin) are appropriate.
Outer ear infections (otitis externa)
Otitis externa — sometimes called "swimmer's ear" — affects the ear canal. Water, humidity, cotton bud use, eczema, and hearing aids all create conditions where bacteria or fungi thrive. The ear canal becomes swollen, painful, and itchy. Discharge is common. Pulling the outer ear or pressing on the tragus (the small flap in front of the canal) typically worsens the pain, which helps distinguish it from middle ear infection.
Treatment is topical: antibiotic/steroid ear drops (such as Sofradex or Otomize) for 7-10 days. Keeping the ear dry during treatment is important. If the canal is very swollen, a doctor may insert a wick (a small sponge) to help the drops reach deeper. Oral antibiotics are only needed if infection has spread beyond the ear canal, causing facial cellulitis or lymph node swelling.
Preventing ear infections
Don't insert cotton buds or any objects into the ear canal. After swimming, tilt your head to let water drain out and dry the outer ear gently. If you're prone to otitis externa, pharmacist-available acetic acid ear spray used after swimming can help maintain the canal's natural acidity.
For children with recurrent middle ear infections (three or more in six months), a referral to an ENT specialist is worth considering. Options include grommets (tiny ventilation tubes) to prevent fluid accumulation.
How we can help
We offer same-day GP appointments for ear pain. The consultation includes otoscope examination to visualise the ear canal and eardrum, identify the type of infection, and determine whether ear drops, oral antibiotics, or a watch-and-wait approach is best. Prescriptions are issued on-site.
For recurrent or persistent infections, we can arrange hearing tests, swab the ear for culture and sensitivity testing, and refer to ENT specialists when needed.
Same-day ear infection consultation
Otoscope examination, diagnosis, and prescription. No GP referral required.
Call 020 7499 1991 or book online.
Dr Mohammad Bakhtiar
Health Screening and Men's Health • GMC 4694470
"Leading our clinical team, Dr Bakhtiar has been seeing patients at Medical Express Clinic for over 20 years. Patients regularly praise his expertise in comprehensive health assessments, sexual health screening, diagnosis and treatment as well as his personable and compassionate approach to care."
View TeamCommon Questions
Q.How do I know if my ear infection is bacterial or viral?
You can't reliably tell from symptoms alone. Most middle ear infections (otitis media) start with a viral upper respiratory infection, and many resolve without antibiotics. A doctor can examine the eardrum with an otoscope — a red, bulging eardrum with fluid behind it suggests bacterial infection that may benefit from antibiotics. Outer ear infections (otitis externa) are more often bacterial or fungal.
Q.Do I need antibiotics for an ear infection?
Not always. NICE guidelines recommend a 'watch and wait' approach for most uncomplicated middle ear infections, as around 80% clear within three days without antibiotics. Your GP may give you a delayed prescription to use if symptoms worsen or don't improve within 48-72 hours. Outer ear infections typically need antibiotic or antifungal ear drops rather than oral antibiotics.
Q.Why do children get more ear infections than adults?
Children's Eustachian tubes (the passages connecting the middle ear to the back of the throat) are shorter, narrower, and more horizontal than adults'. This makes it harder for fluid to drain and easier for infections to travel from the throat to the ear. By age 7, the tubes have grown enough that ear infections become less frequent.
Q.Can I fly with an ear infection?
Flying with a middle ear infection is uncomfortable and can worsen pain. The pressure changes during takeoff and landing stress an already inflamed eardrum. If you must fly, decongestant nasal spray before the flight can help open the Eustachian tubes. Chewing gum or swallowing frequently during descent helps equalise pressure. If the eardrum has perforated, you should avoid flying until it's healed.
Q.When should I take my child to a doctor for an ear infection?
See a doctor if your child is under 2 years old with suspected ear infection, has fluid or discharge coming from the ear, symptoms haven't improved after 3 days, has a temperature above 39°C, seems systemically unwell, or has recurrent ear infections (three or more in six months). Otherwise, pain relief with paracetamol or ibuprofen and monitoring at home is reasonable.
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While our Knowledge Centre provides expert insights, it does not replace a face-to-face consultation with a doctor.
