Knowledge Centre
Providing rapid medical guidance and expert health insights for informational purposes. Our guides come from a Harley Street clinic, but they do not replace a professional consultation.
Ear infections: symptoms, treatment and when to see a GP
Written by Mr Stephen Lingam · Reviewed by Dr Mohammad Bakhtiar (GMC 4694470) on 25/09/2026
Key takeaways
- Most ear infections are either middle ear (otitis media, behind the eardrum) or outer ear (otitis externa, in the ear canal), and each is treated differently.
- A doctor can tell which you have in a minute with an otoscope, and can also spot when earwax or trapped fluid is the real cause.
- Middle ear infections often settle in about 3 days, so antibiotics are kept for the cases that need them, such as under-2s with both ears affected.
- Outer ear infections usually need drops rather than tablets.
- A private GP appointment is £150, seven days a week; children up to 15 are seen in our paediatric clinic on Monday and Wednesday for £200.
It started as a dull ache after a cold, and now the ear feels full, sore and muffled. Or you have been swimming on holiday and the ear canal is so tender that touching your earlobe hurts. With a child, it might be a night of crying, a temperature and a hand that keeps going to one ear.
Ear infections are one of the most common reasons people see a GP, especially children. There are two main types, and both hurt, but they start in different places and need different treatment. A quick look with an otoscope tells the doctor which one you have.
If you would like your ear checked today, a private GP appointment at our Harley Street clinic is £150, seven days a week, and a prescription written at that visit carries no extra clinic fee.
Middle ear or outer ear: which is it?
The two common ear infections compared
| Middle ear (otitis media) | Outer ear (otitis externa) | |
|---|---|---|
| Where | Behind the eardrum | In the ear canal |
| Usually follows | A cold or throat infection | Swimming, humidity, cotton buds, eczema or hearing aids |
| Typical feel | Deep earache, muffled hearing, fever, feeling unwell | Itchy, swollen, tender canal, often with discharge |
| Telling sign | Children pull at the ear, sleep badly and feed poorly | Pulling the earlobe or pressing the flap in front of the canal hurts more |
| Usual treatment | Pain relief; antibiotics for some | Antibiotic and steroid drops or spray |
Earwax can feel very similar. A build-up gives a blocked feeling, dulled hearing, ringing (tinnitus) and sometimes earache, with no infection at all. Cotton buds are the most common avoidable cause, because they push wax deeper rather than removing it. The otoscope check shows straight away whether wax, infection or fluid is behind the symptoms.
Middle ear infections (otitis media)
A cold blocks the Eustachian tube, the narrow channel between the middle ear and the back of the throat. Fluid gets trapped behind the eardrum, and bacteria or viruses multiply in it. The result is earache, reduced hearing on that side, a temperature and feeling generally unwell. Children are often irritable, feed poorly and sleep badly.
Sometimes the pressure makes the eardrum burst, and fluid or pus runs out. That usually eases the pain, and the eardrum normally heals within a few weeks.
NICE advises paracetamol or ibuprofen first, because around 80% of middle ear infections clear within 3 days without antibiotics, and most are gone within a week. Antibiotics, usually amoxicillin for 5 to 7 days, are considered straight away for children under 2 with infection in both ears, for anyone with discharge from the ear, and for anyone who is very unwell. Otherwise the doctor may give a back-up prescription to use if things are not improving after 2 to 3 days.
Outer ear infections (otitis externa)
Otitis externa, often called swimmer's ear, affects the skin of the ear canal. Water, humidity, cotton buds, eczema and hearing aids all create conditions where bacteria or fungi thrive. The canal becomes swollen, itchy and painful, and discharge is common.
Treatment goes straight to the canal. Mild cases can settle with an acidic ear spray from a pharmacy. Most need antibiotic and steroid drops or spray for 7 to 10 days, while keeping the ear dry. If the canal is very swollen, the doctor may place a small sponge wick so the drops reach deeper. Tablets are only needed if the infection spreads beyond the ear canal into the face or neck glands.
If you are prone to otitis externa, tilt your head after swimming to let water drain, dry the outer ear gently, and keep cotton buds out of the canal.
Glue ear and fluid behind the eardrum
Glue ear is fluid that stays in the middle ear after an infection, or builds up on its own. It causes muffled hearing rather than pain, and in children it can show up as not listening, turning the television up or speech that seems slow. The NHS notes that it usually clears within 3 months.
If hearing stays reduced for longer than that, or a child has 3 or more ear infections in 6 months, an ENT specialist is the next step. Options include grommets, tiny tubes placed in the eardrum that let the fluid drain. Our GPs can arrange a specialist referral when it is needed.
When to get an ear seen the same day
Most earaches can wait for a routine appointment, but see a doctor the same day if you notice:
- swelling, redness or tenderness behind the ear, or an ear that sticks out more than before (possible mastoiditis);
- a temperature above 39°C that does not come down with paracetamol;
- sudden hearing loss in one ear, since treatment within 72 hours gives the best result;
- bloody or foul-smelling discharge, or dizziness alongside a blocked ear;
- drooping of the face on the same side as the ear pain.
Severe headache, a stiff neck or confusion alongside an ear infection needs A&E or 999.
Ear infection treatment at 117a Harley Street
Adults and young people aged 16 and over see a GP for £150, seven days a week. The doctor examines the ear canal and eardrum with an otoscope, works out the type of infection, and agrees drops, tablets or a wait-and-see plan with you. Prescriptions are written at the visit. For infections that keep coming back, we can swab the ear to find the exact bacteria, arrange a hearing test and refer you to an ENT specialist.
Children aged 3 months to 15 years are seen in our paediatric clinic on Monday and Wednesday, 10:00 to 14:00, for £200, with time for a full examination. If you are unsure whether a child's ear can wait, our guide on when a child needs a GP sets out the signs. For adults weighing up a private appointment, see when to see a private GP.
Mr Stephen Lingam
Managing Director
Executive leadership
Frequently asked questions
How do I know if my ear infection is bacterial or viral?
You cannot reliably tell from symptoms. Most middle ear infections start with a cold virus and many clear without antibiotics, while a red, bulging eardrum with fluid behind it suggests a bacterial infection that may need them. Outer ear infections are more often bacterial or fungal.
Do I need antibiotics for an ear infection?
Not always. Around 80% of middle ear infections clear within 3 days, so NICE keeps immediate antibiotics for children under 2 with both ears infected, ear discharge or a very unwell patient, and may otherwise give a back-up prescription. Outer ear infections usually need drops rather than tablets.
Where can I get my ear checked in London?
At Medical Express Clinic, 117a Harley Street, a GP can examine your ear for £150, seven days a week, with same-day appointments often available. Children up to 15 are seen in the paediatric clinic on Monday and Wednesday for £200.
Why do children get more ear infections than adults?
Children's Eustachian tubes are shorter, narrower and more horizontal, so fluid drains less easily and infection travels more easily from the throat. By about age 7 the tubes have grown, and ear infections become less frequent.
Can I fly with an ear infection?
Flying with a middle ear infection can make the pain worse, because pressure changes stress an inflamed eardrum. A decongestant nasal spray before the flight and chewing or swallowing during descent can help, and if the eardrum has burst, wait until it has healed.
When should I take my child to a doctor for an ear infection?
See a doctor if your child is under 2, has fluid or discharge from the ear, has not improved after 3 days, has a temperature above 39°C, seems unwell in themselves, or has had 3 or more ear infections in 6 months.
Is it an ear infection or earwax?
Both can cause a blocked feeling, muffled hearing and discomfort. A GP can tell the difference in a minute with an otoscope, which is why an examination is the quickest way to the right treatment.
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