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.

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.